Nutrition and HIV/AIDS: A Training Manual - Linkages Project

Anemia is common during HIV infection (Levine et al 2001), and in the HIV-infectedmother anemia increases the risk of mortality. The causes of anemia in HIV infectionare complex. In developing countries anemia in pregnant or lactating women may bea result of poor dietary intake, poor absorption of iron or other vitamins such asfolate and vitamin B 12 , and co-infections such as malaria and hookworm. For the HIVinfectedpregnant woman, prolonged use of some antiretroviral drugs (ARVs), such asAZT (Zidovudine), can cause anemia that presents as megaloblastic anemia like thatseen with folate or vitamin B 12 deficiency.In many developing countries iron supplementation during pregnancy and lactation isrecommended. Excessive amounts of iron may contribute to HIV disease progression(Clark and Semba 2001; Gorduek et al 2001; Semba et al 2001). However, Clark andSemba (2001) concluded that the available data did not contraindicate the currentpractice of iron supplementation in developing countries with a high prevalence ofboth iron deficiency anemia and HIV. Therefore, pregnant women should receiveiron supplementation to prevent anemia as per the standard of care for pregnantwomen in the country, pending further review of the issue. Table 4 givesWHO/UNICEF guidelines for iron and folic acid supplementation for all pregnantwomen.135