IRON ABSORPTION, LOSSES AND GAINS IN VIRALLY-SUPPRESSED HIV+ CHILDREN

Background HIV+ children are often iron deficient, but the reasons for this are unclear. In HIV+ children, persisting low-grade inflammation may impair iron absorption and/or increase iron losses.

Objective  In HIV+ children compared to children without HIV (HIV-), we measured iron absorption from iron fortificants and supplements, and iron absorption and losses from the habitual diet over 6 months. In HIV+ children, we assessed safety and efficacy of oral iron supplements with and without prebiotic galacto-oligosaccharides (GOS).

Design  In Study 1, in iron-deficient 8-13 y-old HIV+ children and HIV- children (n=90), we measured iron absorption from maize porridge, a lipid-based nutritional supplement (LNS) and an oral iron supplement. In Study 2, we assessed dietary iron absorption and losses over 6 months in the children (n=90) by stable isotope dilution. In Study 3, we performed a 12-week randomized controlled trial comparing oral iron supplements (50mg/day) without and with 7.5g GOS in HIV+ children (n=83). 

Findings  At baseline, the HIV+ group was more iron-deficient (P<0.02) and had more inflammation (P<0.01). In the HIV+ group, habitual dietary iron absorption was 34% lower (P<0.001) and iron gains were 20% lower (P<0.05). In Study 3, the group receiving the iron+GOS had greater iron gains (P<0.02) and less enterocyte damage (P<0.05), compared to iron alone. 

Interpretation  Virally-suppressed HIV+ children have greater inflammation and lower habitual dietary iron absorption and lower iron gains. However, their absorption of oral iron supplements is comparable to HIV- children and providing oral iron with prebiotics may improve efficacy and safety.