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AIDS Factsheet

Side Effects And Their Treatments

Anemia and HIV

Anemia and HIV
Serious anemia used to be much more common. Over 80% of people with an AIDS diagnosis had some degree of anemia. People with more advanced HIV disease, or a lower CD4 count, had higher rates of anemia.

The rate of anemia went down when people started using highly active antiviral therapy (HAART.) Severe anemia has become rare. However, HAART has not eliminated anemia. A large study found that about 46% of patients had mild or moderate anemia, even after one year of HAART.

Several factors are linked to a higher rate of anemia in people with HIV:

Lower CD4 cell counts.
Higher viral load.
Taking AZT (Retrovir).
Being African-American.
Being a woman.

HIV disease progression is about 5 times more common in people with anemia. Anemia is also linked to a higher risk of death. Treatment of anemia seems to eliminate these risks.

AIDS FACT-SHEET

Background Information
-What is AIDS?
-HIV Testing
-Acute HIV Infection
-How HIV Drugs Get Approved
-HIV Life Cycle

Laboratory Tests
-Normal Laboratory Values
-Complete Blood Count (CBC)
-Chemistry Panel
-Blood Sugar and Fats
-CD4 (T-cell) Tests
-Viral Load Tests
-HIV Resistance Testing
-Monitoring Drug Levels

Preventing HIV Infection
-Stopping the Spread of HIV
-How Risky Is It?
-Condoms
-Drug Use and HIV
-Harm Reduction and HIV
-Treatment After Microbicides
-Microbicides

Living with HIV
-Choosing an HIV Care Provider
-Medical Appointments
-Telling Others You are HIV Positive
-Participating in a Clinical Trial
-How to Spot HIV/AIDS Fraud
-Vaccinations and HIV
-Medications to Fight HIV

-HIV Life Cycle
-Taking Current Antiretroviral Drugs
-What Is Antiretroviral Therapy (ART)?
-Adherence
-Treatment Interruptions
-Drug Interactions
-Strengthening the Immune System

-Immune Therapies in Development
-Immune Restoration
-Interleukin-2
-Immune Restoration Syndrome
-Opportunistic Infections

-Opportunistic Infections

Side Effects and Their Treatments
-Side Effects
-Fatigue
-Anemia
-Body Shape Changes (Lipodystrophy)
-Diarrhea
-Peripheral Neuropathy
-Mitochondrial Toxicity
-Bone Problems
-Depression and HIV

Patient Populations

-Women and HIV
-Pregnancy and HIV aids
-Children and HIV
-Older People and HIV

Alternative and Complementary Therapies
-Alternative and Complementary Therapies
-Ayurvedic Medicine
-Chinese Acupuncture
-Chinese Herbalism
-Cat's Claw
-DHEA
-DNCB (Dinitrochlorobenzene)
-Echinacea
-Essiac
-Marijuana
-Silymarin (Milk Thistle)

-Nutrition
-Nutrition
-Vitamins and Minerals
-Exercise and HIV
-Smoking and HIV

What is ANEMIA?
Anemia is a shortage of hemoglobin (HGB). HGB is a protein in red blood cells. It carries oxygen from the lungs to the rest of the body.

Anemia causes fatigue and shortness of breath. People with anemia don't feel as good as people with a normal level of HGB. They find it harder to work. This is called having a lower quality of life.

HGB levels are measured as part of a complete blood count(CBC). HGB is measured as grams per deciliter, the amount in a specific volume of blood.

Anemia is defined by the level of HGB. Most doctors agree that HGB levels below 6.5 indicate life-threatening anemia. Normal levels are at least 12 for women and at least 14 for men.

Overall, women have lower levels of HGB. So do very old and very young people. More African-Americans have anemia than people in other ethnic groups.

What causes ANEMIA?
The bone marrow produces red blood cells. This process requires iron, the vitamins B12 and folic acid (or folate.) Erythropoietin (EPO) stimulates the production of red blood cells. EPO is a hormone made by the kidneys.

Anemia can be caused by low production of red blood cells. It is also caused by their loss or destruction. Several factors can cause anemia:

Too little iron, vitamin B12 or folate. A shortage of folate can cause megaloblastic anemia with large, pale red blood cells
Damage to bone marrow or kidneys
Blood loss from internal bleeding or a woman's menstrual cycle
Destruction of red blood cells (hemolytic anemia)

HIV infection can cause anemia. So can many opportunistic infections related to HIV disease. Many drugs that are commonly used to treat HIV and related infections can cause anemia.

How is ANEMIA treated?
Treating anemia depends on its cause.

First, treat any chronic bleeding. This could be internal bleeding, hemorrhoids, or even frequent nosebleeds.
Next, correct any shortages of iron, vitamin B12 or folate.
Stop using, or reduce the doses of medications that cause anemia.

These approaches might not work. It may not be possible to stop using all medications that cause anemia. Two additional treatments are injections of EPO, and transfusions.

EPO (erythropoietin) stimulates the production of red blood cells. In 1985, scientists learned how to make synthetic EPO. It is injected under the skin, usually once a week. The most common brand of EPO is Procrit�.

A large study of people with HIV found that EPO injections decreased the risk of death. Transfusions seemed to increase it. Because of the risks of transfusions, they are rarely used to treat anemia.

Blood transfusion used to be the only treatment for severe anemia. However, transfusions can cause infection and suppress the immune system. They appear to cause faster progression of HIV disease and to increase the risk of death for HIV patients.

The bottom line
Anemia increases fatigue and makes people feel bad. It increases the risk of disease progression and death. It can be caused by HIV infection or other diseases. Many drugs used to treat HIV and related infections also cause anemia.

Anemia has always been a problem for people with HIV and AIDS. The rate of serious anemia has dropped considerably since people started using HAART. However, almost half of people with HIV still have mild or moderate anemia.

Treating anemia improves the health and survival of people with HIV. Correcting bleeding or shortages of iron, or vitamins are the first steps. If possible, medications that cause anemia should be stopped. If necessary, the patient should be treated with erythropoietin, or, in rare cases, with a blood transfusion.

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AIDS Factsheet

Side Effects And Their Treatments

Anemia and HIV