Serum ferritin levels in human immunodeficiency virus infected children and its relation with severe immunodeficiency

Durgesh Kumar, Mukesh Vir Singh, Indra Kumar Sharma, Dinesh Kumar, Krishan Mohan Shukla, Dhamendra Kumar Singh


Background: Ferritin is an acute phase protein which is often elevated in acute and chronic inflammation. In adults with human immunodeficiency virus (HIV) infection, elevated serum ferritin levels indicate advanced or progressive disease. In the present study, ferritin levels were evaluated in HIV infected children to find out its relation with the immune deficiency.  

Methods: The children who were HIV positive (confirmed by ELISA for HIV-1 and HIV-2), and attending the OPD of ART Centre and of tertiary care center during period of one year were included in the study. The study population consisted of 47 patients, belonging to both sexes and age of 18 months to 19 years. Detailed history was taken and full clinical examination done in all cases. Blood sample for Complete blood count, serum ferritin and CD4 count was taken. Absolute CD4 count of each patient was obtained and immunological staging was done on the basis of WHO immunological staging criteria. Serum ferritin level 7-140 ngm/mL was considered normal.  

Results: Hyperferritenimia (>140 ngm/ mL) is a feature of advanced stages of HIV infection. 11.1% patients of stage 3 and 40.0% patients of stage 4 are showing hyperferritinemia (r = 0.890), irrespective of anemia. Low serum ferritin level (<7 ngm/mL) is an unusual feature in HIV infected children.

Conclusions: High Serum ferritin levels are not uncommon in children with HIV disease and they are related with immunological progression of the disease.


HIV, Serum ferritin, CD4 count, Immunological stage

Full Text:



Meyron-Holtz EG, Moshe-Belizowski S, Cohen LA. A possible role for secreted ferritin in tissue iron distribution. J Neural Transm. 2011;118:337-47.

Lee MH, Means RT Jr. Extremely elevated serum ferritin levels in a university hospital: associated diseases and clinical significance. Am J Med. 1995;98:566-71.

Hearnshaw S, Thompson NP, McGill A. The epidemiology of hyperferritinaemia. World J Gastroenterol. 2006;12:5866-9.

Moroz C, Misrock SL, Siegal FP. Isoferritins in HIV infections: relation to clinical stage, CD8 lymphocyte binding and the pathogenesis of AIDS. AIDS. 2006;3:11-6.

Visser A, Mostert C. Causes of hyperferritinaemia classified by HIV status in a tertiary-care setting in South Africa. Epidemiol Infect. 2012;15:1-5.

Kirn D, Fredericks D, McCutchan JA, Stites D, Shuman M. Marked elevation of the serum ferritin is highly specific for disseminated histoplasmosis in AIDS. AIDS. 1995;9:1204-5.

Riera A, Gimferrer E, Cadafalch J, Remacha A, Martin S. Prevalence of high serum and red cell ferritin levels in HIV-infected patients. Haematologica. 1994 Mar-Apr;79(2):165-7.

Wisaksana R, Sumantri R, Indrati AR, Zwitser A, Jusuf H, Mast QD, et al. Anemia and iron homeostasis in a cohort of HIV-infected patients in Indonesia. BMC Infect Dis. 2011;11:213.

Finch CA, Bellotti V, Stray S, Lipschitz DA, Cook JD, Pippard MJ, et al. Plasma ferritin determination as a diagnostic tool. West J Med. 1986;145:657-63.

Kliegman Robert M, Behrman RE, Jenson HB, Stanton BF. Serum ferritin. In: Kliegman Robert M, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. New Delhi: Elsevier Pub; 2007: 2946.

Calderon CL, Palacios R, Cobo A, Nuno E, Ruiz J, Marquez M, et al. Serum ferritin in HIV-positive patients is related with the immune deficiency and inflammatory activity. Int J STD AIDS. 2015 May;26(6):393-7.

Ellaurie M, Rubinstein A. Ferritin level in HIV-1 infection. Acta Paediatr. 1994;83:1035-7.

Ellen Butensky James, Paul Harmatz, Marion Lee, Christine Kennedy, Ann Petru, Diane Wara, et al. Altered iron metabolism in children with HIV disease. Pediatr Hematol Oncol. 2009;26(2):104-19.

Salhi Y, Costagliola D, Rebulla P, Dessi C, Karagiorga M, Lena-Russo D, et al. Serum ferritin, desferrioxamine, and evolution of HIV-1 Infection in thalassemic patients. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(5):473-8.