IRON-DEFICIENCY AND INTESTINAL MALABSORPTION IN HIV DISEASE

Children with human immunodeficiency virus (HIV) infection have a high er prevalence of intestinal malabsorption. Anemia is also a common fea ture in these children. The aims of this work were (a) to establish th e prevalence of iron deficiency in HIV-infected children, (b) to test the hypothesis that iron deficiency is related to intestinal malabsorp tion, (c) to see whether it may contribute to anemia, and (d) to evalu ate the sensitivity of oral iron load in the investigation of intestin al function. To accomplish these goals, 71 HIV-infected symptomatic ch ildren were enrolled. Iron serum values were determined before and aft er oral load with ferrous sulfate. The correlation between basal and p ost-load iron levels was evaluated by linear regression. Xylose level after oral load, fecal fat, and fecal alpha(1)-antitrypsin concentrati on were also determined. Iron deficiency was detected in 48% of patien ts, and it was significantly associated with intestinal iron malabsorp tion. Sugar malabsorption, steatorrhea, and fecal protein loss were de tected in 26, 36, and 17% of patients, respectively. Low hemoglobin le vels were detected in 66% of patients. The majority of children with i ron deficiency also had anemia. Preliminary data showed that oral iron administration was sufficient for raising hemoglobin in children with normal iron absorption, whereas parenteral administration was require d in those with iron malabsorption. We conclude that (a) iron deficien cy is a major feature of pediatric HIV infection, (b) it is related to intestinal malabsorption, and (c) it contributes to anemia. Finally, oral iron load is a sensitive test for investigating intestinal functi on.