Altered iron metabolism in HIV infection: mechanisms, possible consequences, and proposals for management

The progression of human immunodeficiency virus (HIV) infection toward its more advanced stages is accompanied by increasing body iron stores. Iron accumulates in macrophages, microglia, endothelial cells, and myocytes. The iron burden is especially heavy in bone marrow, brain white matter, muscle, and liver. Excess iron potentially enhances oxidative stress, impairs several already compromised immune defense mechanisms, and directly promotes the growth of microbial cells. Thus, we hypothesize that the prevention (or at least, reduction) of iron loading might slow the progression of the infectious complications of HIV infection, and perhaps indirectly, the HIV infection itself. A twofold strategy is proposed, consisting of (a) limitation of iron intake through the alimentary, parenteral, and respiratory routes, and (b) possibly the use of iron chelator drugs that could decrease the iron burden, redistribute the metal to the erythroblasts, and suppress the growth of microorganisms. This approach is still to be considered as hypothetical. However, the available data suggest that there is an urgent need for careful clinical studies to clarify the role of iron status on the course of HIV infection.