Serum Ferritin is Associated with Hiv Disease Severity & Mortality among Postpartum Zimbabwean Women

The relationship between iron status & HIV infection is complex & poorly understood. While anemia is a major complication of HIV infection, higher iron stores may be associated with disease progression. It is uncertain if increased iron stores are a cause of disease progression or a consequence. There is limited & conflicting data available from Africa, & none that examine this relationship prospectively. We examined the association between post‐partum iron status & viral load (VL), progression (maternal death by 12 months), & MTCT of HIV in 643 HIV+ Zimbabwean women. In non‐anemic women a log10 increase in SF was associated with a 2.3‐fold increase in VL (p=0.02); this association was absent in anemic women. At the same time, Hb was negatively associated with VL (p<0.01). In prospective analyses, a log10 increase in SF was associated with a 3.5‐fold increase in the risk of death by 12 months (p=0.01), but there was no association with MTCT. Controlling for AGP, a marker of inflammation, attenuated the association between SF & VL or progression, but these remained significant. These results are consistent with the hypothesis that high iron stores have adverse consequences in HIV infection, however AGP may not fully control for the effect of HIV on SF (reverse causality). If adverse consequences are real, our data suggest that they occur at SF levels > 45 ug/L, and do not include MTCT.