Interaction between anaemia and human immuno-deficiency virus infection in an asymptomatic population in south africa

Abstract

Anaemia is common and frequent in HIV infection and Acquired Immune Deficiency Syndrome (AIDS). This study was aimed at exploring the interactions between the effects of HIV infection and other related anaemia-causing effects (reductive adaptation, reduced energy/nutrient intake and inflammatory and/or metabolic alterations), which may be responsible for most anaemia in this population. It is postulated that these interactions can heighten the risk levels for anaemia even in an asymptomatic HIV-infected population. The study is based on a secondary analysis of data from the Transition and Health during Urbanisation of South Africans (THUSA) survey, a population-based, cross-sectional study carried out in the North West Province of South Africa. Out of a sample population of 1854 ‘apparently healthy’ adults, aged ?15 years, 216 (11.8%) were HIV sero-positive. A validated quantitative food frequency questionnaire was used to assess dietary intake and standard conditions and protocols used for anthropometric and biochemical measurements.
Anaemia was defined using WHO haemoglobin (Hb) and haematocrit (Hct) definitions. Univariate ANOVA statistics showed that HIV-sero-positive subjects had lower Hb, Hct, serum iron, ferritin, total iron binding capacity (TIBC) but higher % saturation compared to their sero-negative peers. However, only the differences in Hct were significant (p<0.001). Anaemia prevalence was generally high but was higher though not statistically significant in sero-positives than sero-negatives (51.4% cf. 45.8%,p=0.123). Anaemia in the study population was mostly mild (about 65%), with a higher proportion of anaemia of chronic inflammation than iron deficiency anaemia. Vitamin a deficiency was significantly associated with anaemia (p=0.022). High serum total proteins, alanine transaminase (ALT), aspartate transaminase (AST) and low albumin were significantly associated with HIV sero-positivity. Predictors of anaemia in the study population by logistic regression modelling were settlement type (aOR,1.7;CI,1.2-2.5;p=0.004), serum albumin (0.6;0.4-0.9;p=0.016), TIBC (1.5;1.0-2.2;p=0.008), vitamin E (0.6;0.4-0.9;p=0.006), serum gamma-glutamyl transferase (0.6;0.4-0.9;p=0.007), Direct bilirubin (0.5;0.5-1.0;p=0.0446), and abdominal skinfold (1.8;1.2-2.5;p=0.004). HIV infection was not a significant predictor of anaemia in this asymptomatic population, but the virus and related inflammatory conditions may play a crucial role in the development of anaemia. Where HIV and other inflammatory stressors are prevalent, the overall burden of anaemia could also be increased

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