Complex interactions of HIV infection, malaria, and iron deficiency.
Complex interactions of HIV infection, malaria, and iron deficiency.
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HIV 感染、疟疾和缺铁之间复杂的相互作用。
DOI：
10.1093/cid/cit534
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
John,ChandyC
中科院分区：
文献类型：
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作者：
John,ChandyC
人体免疫缺陷病毒（艾滋病毒）感染、疟疾和缺铁是低收入和中等收入国家，特别是撒哈拉以南非洲儿童儿童死亡和丧失发展潜力的最大原因。艾滋病毒感染影响了330万儿童，其中90%生活在撒哈拉以南非洲。据估计，疟疾每年导致100万人死亡，其中大多数是生活在撒哈拉以南非洲的5岁以下儿童。缺铁性贫血每年影响8亿人，其中包括4200万非洲5岁以下儿童，它是阻碍中低收入国家儿童实现其发展潜力的四大最重要因素之一。疟疾和艾滋病毒感染之间的相互作用，特别是在儿童中，仍然知之甚少，但大多数证据表明，感染艾滋病毒的儿童比未感染艾滋病毒的儿童更频繁和更严重的临床疟疾。疟疾和缺铁也有着复杂的关系。缺铁似乎对疟疾流行地区儿童的临床疟疾有保护作用bbb，而在疟疾流行地区补充铁，特别是对缺铁儿童而言，与疟疾和严重不良事件（住院或死亡）风险增加bbb有关。HIV感染与缺铁之间的关系尚不清楚。一些研究表明，感染艾滋病毒的儿童缺铁的频率低于未感染艾滋病毒的儿童，但在艾滋病毒感染期间经常出现的慢性炎症可能会导致这一人群对缺铁的低估，因为炎症会增加铁状态标志物[7]的水平。因此，34%的艾滋病毒阳性儿童缺铁的估计可能是一个低端估计，由于缺铁与神经行为发育受损密切相关[8,9]，缺铁可能是感染艾滋病毒的儿童的一个主要健康问题。艾滋病毒感染、疟疾和缺铁之间的相互作用给撒哈拉以南非洲的儿童保健专业人员留下了一个难题：我们如何在感染艾滋病毒的儿童中补充膳食铁，以防止发育潜力的丧失，同时又不增加这些儿童患疟疾的风险？
Human immunodeficiency virus (HIV) infection, malaria, and iron deficiency are among the greatest contributors to childhood mortality and the loss of developmental potential in children in lowand middle-income countries, notably in sub-Saharan Africa. HIV infection affects 3.3 million children,> 90% of whom live in sub-Saharan Africa [1]. Malaria is estimated to kill> 1 million people every year, the majority of whom are children< 5 years of age living in sub-Saharan Africa [2]. Iron deficiency anemia affects 800 million people annually, including 42 million African children< 5 years of age, and it is one of the 4 most important factors preventing children in low-and middle-income countries from meeting their developmental potential [3]. The interactions between malaria and HIV infection, particularly in children, are still poorly understood, but the majority of evidence indicates that HIV-infected children have more frequent and more severe clinical malaria than children not infected with HIV [4]. Malaria and iron deficiency also have a complex relationship. Iron deficiency appears to be protective against clinical malaria in children in malaria-endemic areas [5], and iron supplementation in malaria-endemic areas, particularly in iron-replete children, has been associated with an increased risk of malaria and severe adverse events (hospitalization or death)[6]. The relationship between HIV infection and iron deficiency is less well characterized. Some studies indicate that children infected with HIV have iron deficiency less frequently than children without HIV infection, but the chronic inflammation often seen during HIV infection might lead to underestimates of iron deficiency in this population, because inflammation increases the levels of markers of iron status [7]. Thus, the estimate that 34% of HIV-positive children are iron deficient is likely a low-end estimate, and since iron deficiency is strongly associated with impaired neurobehavioral development [8, 9], iron deficiency is likely a major health problem for children infected with HIV. The interactions between HIV infection, malaria, and iron deficiency leave child health professionals in sub-Saharan Africa with a conundrum: how do we supplement dietary iron in HIV-infected children to prevent the loss of developmental potential without increasing risk of malaria in these children?