Minimal impact of an iron-fortified lipid-based nutrient supplement on Hb and iron status: A randomised controlled trial in malnourished HIV-positive African adults starting antiretroviral therapy
British Journal of Nutrition
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania; University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Vanderbilt Institute for Global Health, Nashville, TN, United States; Department of Medicine, Vanderbilt University, School of Medicine, Nashville, TN, United States
Anaemia, redistribution of Fe, malnutrition and heightened systemic inflammation during HIV infection confer an increased risk of morbidity and mortality in HIV patients. We analysed information on Fe status and inflammation from a randomised, double blind, controlled phase-III clinical trial in Lusaka, Zambia and Mwanza, Tanzania. Malnourished patients (n 1815) were recruited at referral to antiretroviral therapy (ART) into a two-stage nutritional rehabilitation programme, randomised to receive a lipid-based nutrient supplement with or without added micronutrients. Fe was included in the intervention arm during the second stage, given from 2 to 6 weeks post-ART. Hb, serum C-reactive protein (CRP), serum ferritin and soluble transferrin receptor (sTfR) were measured at recruitment and 6 weeks post-ART. Multivariable linear regression models were used to assess the impact of the intervention, and the effect of reducing inflammation from recruitment to week 6 on Hb and Fe status. There was no effect of the intervention on Hb, serum ferritin, sTfR or serum CRP. A one-log decrease of serum CRP from recruitment to week 6 was associated with a 1·81 g/l increase in Hb (95 % CI 0·85, 2·76; P< 0·001), and a 0·11 log decrease in serum ferritin (95 % CI - 0·22, 0·03; P= 0·012) from recruitment to week 6. There was no association between the change in serum CRP and the change in sTfR over the same time period (P= 0·78). In malnourished, HIV-infected adults receiving dietary Fe, a reduction in inflammation in the early ART treatment period appears to be a precondition for recovery from anaemia. © The Authors 2015.
antiretrovirus agent; C reactive protein; efavirenz; emtricitabine; ferritin; hemoglobin; lamivudine; lipid; nevirapine; tenofovir; transferrin receptor; zidovudine; antiretrovirus agent; C reactive protein; ferritin; hemoglobin; iron; iron intake; lipid; adult; anemia; Article; blood sampling; controlled study; disease association; disease severity; double blind procedure; female; hemoglobin blood level; human; Human immunodeficiency virus infection; inflammation; iron blood level; iron metabolism; iron therapy; male; malnutrition; phase 3 clinical trial; protein blood level; randomized controlled trial; Tanzania; treatment duration; treatment response; administration and dosage; anemia; blood; complication; deficiency; diet supplementation; diet therapy; HIV Infections; iron intake; malnutrition; metabolism; mortality; Zambia; Adult; Anemia; Anti-Retroviral Agents; C-Reactive Protein; Dietary Supplements; Double-Blind Method; Female; Ferritins; Food, Fortified; Hemoglobins; HIV Infections; Humans; Inflammation; Iron; Iron, Dietary; Lipids; Male; Malnutrition; Tanzania; Zambia