Anemia has long been an attendant problem to chronic and inflammatory diseases, such as HIV infection. There are many types of anemia, including iron- or folate-deficiency anemia, anemia caused by medication (for example, zidovudine), and anemia caused by chronic disease. The consequences of anemia include fatigue and inadequate oxygenation of tissues as well as further deterioration of immune function, all of which can lead to problems in fitness and nutrition. If you have anemia, you can get a differential diagnosis to find out which kind you have. If you have iron-deficiency anemia, there are important things to consider in figuring out how best to treat it.
In one study in which antiretroviral therapy was initiated and successfully lowered viral loads, anemic patients showed significant gains in red blood cells. This suggested that decreasing immune activation can decrease the sequestration of iron, allowing it to become available for red blood cell production. While anemia can be common with chronic disease, it is a good idea to determine if your diet is adequate in nutrients to keep it at bay. Any diet or supplementation strategies should be combined with adequate treatment for HIV and opportunistic infection to reduce the potential for problems.
For people without chronic disease, the typical treatment for iron-deficiency anemia is an iron supplement. But with chronic disease, iron supplementation can pose problems. When the immune system is activated, as in cases of high viral load or an opportunistic infection, iron is withdrawn and sequestered in the body. This means that iron is less available but that the overall amount of iron in the body may not be low. If iron is supplemented, it continues to be sequestered and unavailable for use in reversing anemia, but it may become more available to iron-loving bacteria and even cause iron toxicity. Iron supplementation in subgroups with HIV infection has been associated with progression of HIV disease, higher mortality, and shorter survival times.
Improving iron levels is most safely done through food choices. The recommended daily iron intake is between eight and 18 milligrams a day. The upper limit, in which toxicity symptoms can occur, is set at 45 milligrams a day. In your quest to improve your iron intake you should remember that it is still important to maintain a balanced diet. High-iron foods are typically low in calcium and vice versa'and you need an adequate amount of both of these nutrients. Meats are typically high in iron in its readily absorbable form: heme iron. An eight-ounce lean steak or the same amount of pot roast can have around seven to eight milligrams of iron. There are a number of plant-based foods that are good sources of iron, but it is in the form of nonheme iron, which requires a little more thought and effort to assure absorption. Nonheme iron from plant-based sources is well absorbed if consumption is accompanied by fruits and vegetables or a source of vitamin C. So, for instance, if you have one cup of cooked navy beans or soybeans along with broccoli or cauliflower or follow it closely with a refreshing dessert of papaya or cantaloupe, you can better absorb its eight milligrams of iron. A superpowered breakfast may include a one-cup bowl of Cream of Wheat with two ounces of dried peach slices for a whopping 12 milligrams of iron to start your day'with only 300 calories (for those of you watching your weight)! Check with your dietitian to ensure that you get adequate iron in your diet and for ideas on how best to consume foods to absorb the iron you need.
Fields-Gardner is the director of services for the Cutting Edge, an HIV nutrition company in the Chicago area. She is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS. She has written a book on HIV medications and a guide to nutritional management of HIV for clinicians.
