Handouts: Anemia & HIV/AIDS

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Glossary
Autoimmune destruction: Body destroys its own cells

AZT: zidovudine, an antiviral drug

Blood transfusion: Transfer of blood or any of its parts to a person

HAART: Highly Active Anti-Retroviral Therapy

Hematocrit: Percentage of red blood cells in a blood sample

Hemoglobin: Protein carried by red blood cells that transports and delivers oxygen throughout your body

Inflammation: Your body’s response to injury or irritation; often associated with pain, redness, heat, and/or swelling

Opportunistic infections: An infection suffered by a person whose immune system is not working normally

What is anemia?
Anemia is a below-normal level of hemoglobin* or hematocrit*. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body. Anemia can be a temporary condition, a consequence of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and can feel tired or experience shortness of breath with activity.1

How common is anemia in people with HIV/AIDS?
The chance of developing anemia becomes greater with AIDS.1 Anemia occurs in about 30% of people with HIV, but the rate is 75-80% of people with AIDS.2

What causes anemia in people with HIV/AIDS?
There are many causes of anemia in HIV and AIDS patients. As a result of the inflammation associated with HIV/AIDS, you may not be able to produce enough red blood cells. Less common causes for HIV-associated anemia include vitamin B12 deficiency and the autoimmune destruction of red blood cells.1 Some of the early drugs used to treat HIV/AIDS, such as AZT, were shown to be a possible cause of anemia.3 However, the newer HAART drugs are much less likely to cause anemia.4

What are the effects of untreated anemia in HIV/AIDS?
Fatigue and other symptoms associated with anemia can interfere with daily activities. Anemia also increases the chance that HIV infection will progress to AIDS. Studies show people with HIV and those with AIDS who are anemic have a shorter life expectancy than people without anemia.5,6 While managing anemia may be life saving in some circumstances, treatment has not proven to guarantee a longer lifespan.

How do I know if I have anemia?
The best way to determine if you have anemia is to discuss your blood counts and changes in hemoglobin and hematocrit with your doctor. Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache. It is important to see your doctor on a regular basis in order to be tested for possible anemia.

What treatments are available to help me?
If you have anemia-associated vitamin deficiencies, correction of these deficiencies is recommended. Certain people with severe anemia may need a blood transfusion;7 however, transfusions are avoided whenever possible in HIV/AIDS patients because transfusions have been shown to increase the risk of opportunistic infections and death.8,9 Drugs that stimulate the production of red blood cells have been approved for treating anemia in HIV/AIDS. These drugs reduce the need for blood transfusions in people with HIV/AIDS, improve energy levels, and suggest an overall improvement in quality of life.10,11 Close communication with your doctor will help him or her provide the treatment that is best for you based on what is causing the anemia.

*Normal Lab Values: Normal hemoglobin >12 g/dL for women, >13 g/dL for men; normal hematocrit >36% for women, >39% for men.

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References

  1. [Cited source redacted; replace with a supporting citation.]
  2. Levine AM, et al. J Acquir Immune Defic Syndr. 2001;26:28-35.
  3. Bain BJ. Curr Opin Hematol. 1999;89-93.
  4. Servais J. J Acquir Immune Defic Syndr. 2001:28:221-225.
  5. Sullivan P. J Infect Dis. 2002;185(suppl 2):S138-S142.
  6. Volberding P. Clin Ther. 2000;22:1004-1020.
  7. Claster S. J Infect Dis. 2002;185(suppl 2):S105-S109.
  8. Moore RD, et al. J Acquir Immune Defic Syndr. 1998:19:29-33.
  9. Sloand E, et al. Transfusion. 1994;34:48-53.
  10. Abrams DI, et al. Int J STD AIDS. 2000;11:659-665.
  11. Volberding P. J Infect Dis. 2002;185(suppl 2):S110-S114.

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