Iron status and anaemia of chronic disease in HIV-infected African women in Mangaung, Bloemfontein

Abstract

Background: Anaemia occurs widely among people living with HIV/AIDS. The aim of this study was to investigate the effect of HIV status on iron
status, more specifically to investigate the nutritional health of women between 25 and 44 years of age.
Methods: An epidemiological study was undertaken in Mangaung, a black residential community of Bloemfontein in the Free State (South Africa).
A random sample consisted of 500 women in two age groups (25–34 [n = 273] and 35–44 years [n = 215]). Blood specimens were collected in ethyldimethylacetic acid collection tubes according to standard procedures. Respondents fasted overnight, abstained from exercise and avoided consuming alcohol and caffeine for 24 hours prior to collection of the blood specimens. All specimens were taken in the morning. A full blood count was performed using a Coulter Microdiff 18 Cell Counter. The metabolic variables haematocrit (Hct), haemoglobin (Hb), serum iron, ferritin and transferrin were determined. The red blood cell count was performed to calculate the mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). Age and HIV-status groups were described and compared by nonparametric methods. A p-value lower than 0.05 was considered significant. HIV-infected and -uninfected groups were compared by 95% confidence intervals for the difference in the percentage of women with parameters below or above the normal range.
Results: Sixty-one per cent of the younger women and 38% of the older women were HIV infected. The percentage with serum ferritin levels below
20 μg/L was higher in HIV-uninfected women, ranging from 0% in older HIV-infected women to 10.4% in younger HIV-uninfected women. A large
percentage of women had elevated transferrin values, ranging from 23.9% in older HIV-infected women to 44.8% in older HIV-uninfected women.
A large percentage of women had anaemia of chronic disease, with HIV-infected women afflicted more often.
Conclusion: The results of the study indicate that prevalence of HIV infection in Mangaung is high, especially among women between 25 and
34 years of age. Although the parameters of iron status on average did not indicate iron deficiency in the different age and HIV-status groups, a large percentage of women did have anaemia of chronic disease, with HIV-infected women afflicted more often. Knowledge of the HIV status of a patient is of paramount importance in evaluating laboratory results of iron levels to determine future treatment or nutritional recommendations. HIV-infected and -uninfected individuals might not be comparable regarding their laboratory results to interpret iron store depletion, with consequences for further therapeutic actions in these two groups. The progression rate to AIDS might also be enhanced by certain interventions.

Keywords: iron; HIV; nutrition; women; South Africa