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Anaemia is prevalent in approximately 500 000 children living with HIV worldwide1 and is associated with increased risk of mortality and unsuppressed viral load.2–4 There are no standard guidelines to treat mild-to-moderate anaemia in the context of HIV infection, although many clinicians prescribe iron supplements to treat it. Oral iron might treat anaemia in children living with HIV,4,5 despite concerns that HIV-related systemic inflammation dampens iron absorption in the gastrointestinal tract.6 There are also concerns that iron repletion after supplementation might accelerate viral replication and increase the risk of opportunistic infections.3,5,7 However, observational studies have suggested that iron supplementation might reduce mortality risk, although they were substantially affected by confounding.