Assessment of iron status using plasma transferrin receptor in pregnant women with and without human immunodeficiency virus infection in Malawi

Abstract

Although anemia is highly prevalent during pregnancy and is common during human immunodeficiency virus (HIV) infection, anemia and iron status have not been well characterized in HIV-infected pregnant women. To gain insight into iron status in HIV-infected pregnant women using plasma transferrin receptor and related indicators of anemia. Plasma transferrin receptor, ferritin, a1-acid glycoprotein, C-reactive protein and haemoglobin concentrations were measured in pregnant women, gestational age 18 ± 28 weeks, seen in an urban antenatal clinic in Blantyre, Malawi. The prevalence of anemia among 662 HIV-positive and 190 HIV-negative pregnant women was 73.1% and 50.0%, respectively (P<0.0001). Among HIV-positive and HIV-negative women, median plasma transferrin receptor concentrations were 24.4 and 24.1 nmol=l (Pˆ0.5), respectively, and median plasma ferritin concentrations were 17.8 and 20.8 mg=l (P<0.05), respectively. There was a large overlap in plasma transferrin receptor concentrations among women with and without anemia. Using the combination of hemoglobin and ferritin as a standard, the sensitivity and specificity of plasma transferrin receptor in diagnosing iron deficiency anemia was estimated at 45.9% and 68.1%, respectively. The use of plasma transferrin receptor concentrations as an indicator of iron deficiency anemia may be limited in pregnant women with chronic inflammation and infection. The National Institutes of Health (HD32247, HD30042, HIVNET contract N01-AI-35173-117), the Fogarty International Center, and the United States Agency for International Development (Cooperative Agreement HRN-A-00-97-00015-00). Pregnancy; iron; iron deficiency anemia; transferrin receptor; ferritin; hemoglobin; human immunodeficiency virus; Malawi