http://www.nwo.nl/projecten.nsf/pages/2300130415

Project 2: Randomized Placebo Controlled Trial of iron supplementation
in HIV infected children: Is iron safe and beneficial?

Severe anaemia is common among HIV infected children in Africa and an
indicator of poor prognosis. Iron supplementation is a relatively cost-
effective strategy for preventing and controlling anaemia and is
recommended by WHO in highly endemic countries. However, there is
increasing evidence that iron supplementation in HIV infected patients
provides little haematological benefits, may increase susceptibility
to bacterial infections and malaria, and increases viral load. We
hypothesize that iron supplementation in HIV infected children is
associated with an increased morbidity while providing little
haematological benefit. We will conduct a double blind randomised
controlled trial of iron supplementation versus placebo in the post-
discharge management of HIV-infected children with mild anaemia and
compare the incidence of sick child clinic visits and haemoglobin
concentration by 3 and 6 months post-discharge.

Anaemia in pregnant women:

Malaria, HIV and iron deficiency are also the main causes of severe
anaemia in pregnant women. The WHO recommends routine use of iron
supplementation in all pregnant women living in areas with a high
prevalence of iron-deficiency. Similar to children, there is little
evidence to show that this is effective in HIV-infected pregnant
women, however, while evidence accumulates that this may increase
morbidity.

Project 3: A study of the effects of iron supplementation in HIV-
infected pregnant women.

We hypothese that iron supplementation in HIV-infected pregnant women:
1) is ineffective in preventing anemia, 2) increases the risk and
density of malaria infection, 3) leads to increased deposition of iron
in the bone marrow, and 4) increases HIV viral load. We will compare
the rates of maternal anemia (primary outcome), density of malaria
parasitemia, and concentrations of several iron and HIV laboratory
markers (secondary outcome) in pregnant women who receive iron
supplementation and those who do not. This will be an observational
study.

The results of the three projects will provide an important
contribution to the development of safe and more targeted
interventions for the control of anaemia in the two main risk groups
(children and pregnant women) that may increase effectiveness of
control programs, at a reduced risk for morbidity and reduced costs.
The results will benefit other countries with similar patterns of
malaria, HIV and iron deficiency in the Southern African sub-region.

Who loves ya.
Tom

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