The prevalence and etiology of anemia among HIV-infected children in India

Anita Shet, Karthika Arumugam, Nirmala Rajagopalan, Chitra Dinakar, Shubha Krishnamurthy, Saurabh Mehta, Arun S. Shet

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17 Scopus citations


In this report, the prevalence and multifactorial etiology of anemia among Indian human immunodeficiency virus (HIV)-infected children are described. HIV-infected children aged 2-12 years were prospectively enrolled in 2007-2008. Measured parameters included serum ferritin, vitamin B12, red-cell folate, soluble transferrin receptor, and C-reactive protein. Children received antiretroviral therapy (ART), iron and, folate supplements as per standard of care. Among 80 enrolled HIV-infected children (mean age 6.8 years), the prevalence of anemia was 52.5%. Etiology of anemia was found to be iron deficiency alone in 38.1%, anemia of inflammation alone in 38.1%, combined iron deficiency and anemia of inflammation alone in 7.1%, vitamin B12 deficiency in 7.1%, and others in 9.5%. Median iron intake was 5.7 mg/day (recommended dietary allowance 18- 26 mg/day). Compared to nonanemic children, anemic children were more likely to be underweight (weight Z-score -2.5 vs. -1.9), stunted (height Z-score -2.6 vs. -1.9), with lower CD4 counts (18% vs. 24%, p<0.01), and higher log viral load (11.1 vs. 7.1, p<0.01). Hemoglobin (Hb) improved significantly among those who started ART (baseline Hb 11.6 g/dl, 6-month Hb 12.2 g/dl, p=0.03). Children taking ART combined with iron supplements experienced a larger increase in Hb compared to those receiving neither ART nor iron supplements (mean Hb change 1.5 g/dl, p<0.01). Conclusion Anemia, particularly iron deficiency anemia and anemia of inflammation, is highly prevalent among children with HIV infection. Micronutrient supplements combined with ART improved anemia in HIV-infected children.

Original languageEnglish (US)
Pages (from-to)531-540
Number of pages10
JournalEuropean Journal of Pediatrics
Issue number3
StatePublished - Mar 2012
Externally publishedYes


  • Anemia
  • Anemia of inflammation
  • Children
  • HIV
  • India
  • Iron
  • Resource-limited

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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