Iron Deficiency and Neurobehavioral Outcomes in Ugandan Children Exposed to HIV

The prevalence of iron deficiency (ID) among children exposed to HIV in utero is unclear, and an association with ID and neurobehavioral deficits has not been investigated.

We assessed iron status in Ugandan children aged 6 to 59 mo who were HIV-infected (HI), exposed to HIV but uninfected (HEU), or not exposed to HIV (HUU) and examined the relationship with neurobehavioral outcomes.

We enrolled children who were HI (n = 70), HEU (n = 70), or HUU (n = 70) and conducted assessments of cognition, attention, executive function, and socioemotional behavior. We used logistic regression to compare ID prevalence among the groups and tested for associations between iron status and neurobehavioral outcomes, using the HUU group to calculate age-adjusted Z-scores.

More than 40% of children in each group had ID (plasma ferritin <12 or <30 μg/L if C-reactive protein >10 mg/L). Children who were HEU had a higher prevalence of ID than children who were HI (59.4% compared with 42%, P = 0.04) and a higher prevalence of ID with anemia (IDA) than children who were HUU (32.4% compared with 18.8%, P = 0.04). Overall, children with ID scored lower in fine motor {adjusted Z-score [95% confidence interval (CI)] for ID compared with not ID: -0.20 [-0.4, -0.03] compared with 0.07 [-0.09, 0.24]}, but there were no other differences by ID. Children with IDA, particularly those who were HI, had poorer socioemotional behavior, exhibiting poorer exploration quantity [adjusted odds ratio IDA compared with not IDA (95% CI): 0.39 (0.17, 0.92)], greater fear [4.5 (1.6, 12.1)], less positive affect [0.44 (0.23, 0.87)], and less adaptability [0.38 (0.17, 0.82)].

There is a significant burden of ID among Ugandan children, including those who are HI and HEU. IDA was associated with poorer socioemotional behavior, highlighting the need to study the safety and efficacy of early-life iron interventions to optimize neurobehavioral development in this population.