Iron Supplements Actually Benefit Children with HIV

Iron supplements are safe for kids with HIV living in Uganda, according to new research by the University of Minnesota Medical School published in the November issue of The Lancet HIV. The iron supplements also did not increase malaria infection rates, disproving previews concerns that they did.

Hemoglobin is the protein in red blood cells responsible for transporting oxygen throughout the body. Iron improves hemoglobin concentration in the blood, therefore reducing the risk of anemia. If left unchecked, anemia can lead to heart problems, a weakened immune system and organ failure. If someone is already HIV-positive, anemia adds to the burden.

Children 6 to 59 months of age are considered anemic of their values fall below 11 g/dL and children 5 to 11 years are old are considered anemic if their values fall below 11.5 g/dL.

Iron deficiency is the most common nutritional deficiency in the world, the current study reads. In addition, about 39.7% of HIV-positive children 15 and younger are iron deficient. Despite this, some pediatricians don’t prescribe iron supplements, partly due to fears of increased malaria infection risk raised by the results of a study published in 2013.

However, the children who contracted malaria during that study were not sleeping under insecticide treated bed nets and only a third of total participants were on antiretroviral therapy (ART).

For the current study, which took place from May 2018 to November 2019, researchers enrolled 200 HIV-positive children who were on ART for at least six months, taking co-trimoxazole prophylaxis and sleeping under insecticide treated bed nets. The participants, between 6 months old and 12 years old, received either iron supplements or placebo for three months. Supplement dosage was dependent on age and given at home after a meal, preferably in the evening. Children 6–23 months old received tablets of 12.5 mg of ferrous sulphate and children 24 months and older were given 30 mg of ferrous sulphate.

At day 0, mean baseline of hemoglobin for both the placebo and treatment group was 11.5 g/dL. At the end of the study, the iron supplement group had hemoglobin values of 12.0 g/dL and the placebo group had values of 11.7 g/dL.

“Our findings support the WHO recommendation that iron supplements can be given to children living with HIV and moderate anemia who are taking ART, taking co-trimoxazole prophylaxis, and sleeping under insecticide-treated bed nets,” co-author Anne Frosch, M.D., M.P.H., infectious disease expert at Hennepin Healthcare Research Institute in Minneapolis, Minnesota. “Future studies should assess neurodevelopmental outcomes and infectious risks, including malaria, in children living with HIV taking iron supplements.”