TY - JOUR

T1 - Minimal impact of an iron-fortified lipid-based nutrient supplement on Hb and iron status

T2 - a randomised controlled trial in malnourished HIV-positive African adults starting antiretroviral therapy

AU - James, Philip

AU - Friis, Henrik

AU - Woodd, Susannah

AU - Rehman, Andrea M

AU - PrayGod, George

AU - Kelly, Paul

AU - Koethe, John R

AU - Filteau, Suzanne

N1 - CURIS 2015 NEXS 250

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

U2 - 10.1017/S0007114515001920

DO - 10.1017/S0007114515001920

M3 - Journal article

C2 - 26179616

VL - 114

SP - 387

EP - 397

JO - British Journal of Nutrition

JF - British Journal of Nutrition

SN - 0007-1145

IS - 3

ER -