The association of serum ferritin and transferrin receptor concentrations with mortality in women with human immunodeficiency virus infection

Background and Objectives. Whether degree of iron stores influences progression of human immunodeficiency virus (HIV) disease is controversial. We studied the relationship of indirect measures of iron stores with mortality in highly active antiretroviral therapy (HAART)-naïve participants from the Women's Interagency HIV Study. Design and Methods. One hundred and fifty-eight HIV-infected women who died before July 1996 were individually matched by CD4⁺ cell count (within ±50 cells/μL) and HIV RNA level (within ±0.50 log₁₀ copies/mL) to 154 controls. Serum ferritin and transferrin receptor concentrations were measured in 151 pairs of women. Results. Using multivariable conditional logistic regression models that were adjusted for self-reported antiretroviral therapy use, age, smoking status, ethnicity, hemoglobin concentration, C-reactive protein and aspartate amino transferase, a log₁₀ increase in baseline serum ferritin concentration was associated with a 1.67-fold increase in the odds of death (95% CI: 0.98, 2.86) and a one-unit decrease in transferrin receptor to log ₁₀ ferritin ratio was associated with a 1.12-fold (95% CI: 1.01, 1.23) increase in the odds of death. Interpretations and Conclusions. In this study, higher indirect measures of iron status were associated with reduced survival among HAART-naïve HIV-infected women. Additional prospective studies with data or direct measures of iron status along with randomized trials are needed to elucidate the current equipoise over whether iron supplementation is beneficial by preventing anemia or harmful by increasing iron stores in HIV-infected women.