HIV and iron-deficiency anaemia

Predictors of HIV and iron-deficiency anaemia: a comment

Madam

I read the recent article on HIV and Fe-deficiency anaemia by Finkelstein et al., published online in your journal, with great interest⁽ Reference Finkelstein, Mehta and Duggan ^{1 )}. The authors reported that ‘micronutrient supplementation and infectious disease control, is warranted in HIV-infected women in resource-limited settings’⁽ Reference Finkelstein, Mehta and Duggan ^{1 )}. I agree completely with this useful suggestion. Indeed, the prevalence of both HIV and anaemia is still high in developing countries and these two diseases need focus in antenatal care⁽ Reference Oladeinde, Phil and Olley ^{2 )}. However, some facts should be noted. First, in a recent publication it is mentioned that HIV does not increase the risk of anaemia among the pregnant⁽ Reference Oladeinde, Phil and Olley ^{2 )}. This report might be discordant with Finkelstein et al.'s finding that immunity, specifically CD4 T-cell count, can take a role. The explanation might lie in the different settings and numbers of subjects. Second, in Finkelstein et al.'s work, although the authors tried to study several parameters, there might be some pitfalls. The quality control of the determination of Hb should be discussed. Also, there is no proof for Fe-deficiency anaemia by Fe status in the study subjects. It should be noted that a similar picture, i.e. presentation of anaemia with hypochromic microcytic blood, can be seen in cases with congenital Hb disorder such as thalassaemia and this can be a confounding factor that was not well controlled for in Finkelstein et al.'s work.