Kupka Roland, Msamanga Gernard I, Mugusi Ferdinand, Petraro Paul, Hunter David J, Fawzi Wafaie W
Department of Nutrition, Harvard School of Public Health, Boston, MA 02125, USA.
J Nutr. 2007 Oct;137(10):2317-23. doi: 10.1093/jn/137.10.2317.
In HIV-infected populations from developing countries, it is unclear what proportion of anemia is attributable to iron deficiency (ID) and whether high body iron stores worsen HIV disease progression. We therefore evaluated these research questions in 584 HIV-infected Tanzanian women. Hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (sTfR), and C-reactive protein (CRP) concentrations were evaluated between 13 and 43 wk after women gave birth. ID was defined as SF or sTfR outside normal ranges, and ID anemia (IDA) as ID plus low Hb. In multivariate Cox regression models, the association between SF and HIV disease progression was assessed. Participants received iron + folate supplements during pregnancy. Hb (r = -0.159; P = 0.0001), SF (r = 0.355; P < 0.0001), and sTfR/log SF index (r = -0.119; P = 0.004) were related to CRP, whereas sTfR (r = 0.029; P = 0.48) was not. Prevalence estimates were 39.7% for ID and 23.6% for IDA. ID was associated with 48.9% of anemia cases. Categories of SF were not significantly associated with HIV-related mortality or progression to stage 4. Nevertheless, SF > 150.0 microg/L was related to a nonsignificantly elevated risk of progression to stage 4 (rate ratio = 1.78; 95% CI = 0.68-4.64; P = 0.24) compared with SF < 12.0 microg/L. In HIV-infected, parous women from sub-Saharan Africa, ID is of moderately high prevalence and is an important underlying cause of anemia. High storage iron does not appear to be related to HIV disease progression in this population, but more research on the role of iron during HIV disease is needed.
在发展中国家的艾滋病毒感染人群中，尚不清楚贫血有多大比例可归因于缺铁（ID），以及体内铁储备过高是否会加剧艾滋病毒疾病的进展。因此，我们在584名感染艾滋病毒的坦桑尼亚妇女中对这些研究问题进行了评估。在妇女分娩后的13至43周内，对血红蛋白（Hb）、血清铁蛋白（SF）、血清转铁蛋白受体（sTfR）和C反应蛋白（CRP）浓度进行了评估。ID定义为SF或sTfR超出正常范围，缺铁性贫血（IDA）定义为ID加上低Hb。在多变量Cox回归模型中，评估了SF与艾滋病毒疾病进展之间的关联。参与者在怀孕期间接受了铁+叶酸补充剂。Hb（r = -0.159；P = 0.0001）、SF（r = 0.355；P < 0.0001）和sTfR/log SF指数（r = -0.119；P = 0.004）与CRP相关，而sTfR（r = 0.029；P = 0.48）则不然。ID的患病率估计为39.7%，IDA为23.6%。ID与48.9%的贫血病例相关。SF类别与艾滋病毒相关死亡率或进展至4期无显著关联。然而，与SF < 12.0 μg/L相比，SF > 150.0 μg/L与进展至4期的风险非显著升高相关（率比 = 1.78；95% CI = 0.68 - 4.64；P = 0.24）。在撒哈拉以南非洲感染艾滋病毒的经产妇中，ID患病率中等偏高，是贫血的一个重要潜在原因。在该人群中，高铁储备似乎与艾滋病毒疾病进展无关，但需要对铁在艾滋病毒疾病中的作用进行更多研究。
