Anemia is a clinically significant complication of infection with HIV, especially in patients who develop clinical AIDS. Several large studies have demonstrated that HIV-infected women, particularly African–American women, are disproportionately affected by anemia. These studies also reveal an association between anemia and statistically significant decreases in survival. In this review, the impact of anemia, the demographic characteristics of affected patients and the known risk factors for development of anemia in HIV-infected women are discussed. In addition, the diverse etiologies of anemia in the setting of HIV infection are reviewed, as are current treatment recommendations.
Papers of special note have been highlighted as either of interest (•) or of considerable interest (••) to readers.
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SullivanPSHansonDLChuSY: Epidemiology of anemia in human immunodeficiency virus infected persons: results from the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project. Blood91, 301–308 (1998).
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One of the largest epidemiologic studies of anemia in HIV-infected patients.
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CreaghTMildvanD: Greater prevalence of anemia in women and African Americans with HIV/AIDS in the HAART era: a study of 10,000 patients. The Anemia Prevalence Study Group. Program and Abstracts of the 40th Annual Meeting of the Infectious Diseases Society of America.Chicago, Alexandria, VA, USA: Infectious Diseases Society of America, 127 (2002) (Abstract 475).
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MocroftAKirkOBartonSE: Anemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. EuroSIDA Study Group. AIDS13, 943–950 (1999).
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One of the first large cohort studies to link anemia to inferior survival in HIV-infected patients.
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LevineAMBerhaneKMasri-LavineL: Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women's Interagency HIV Study. J. Acquir. Immune Defic. Syndr.26, 28–35 (2001).
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This study from the Women's Integracy HIV Study (WIHS) is one of the largest and most thorough examinations of anemia in HIV-infected women.
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SembaRDShahNKleinRS: Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus-infected and -uninfected women. Clin. Infect. Dis.34, 260–266 (2002).
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Study from the Human immunodeficiency Epidemiology Research Study (HERS) cohort was the first to corroborate the negative impact of anemia on survival in a large group of HIV-infected women.
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SaagMSBowersPLeitzGJLevineAM: Once-weekly epoetin alfa improves quality of life and increases hemoglobin in anemic HIV+ patients. AIDS Res. Hum. Retroviruses20, 1037–1045 (2004).
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Large, prospective study on the use of erythropoietin includes HIV-infected patients with a hemoglobin count less than 11 g/dl, without AIDS and receiving antiretroviral therapy, using hemoglobin and quality of life as efficacy endpoints.
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GrossmanHAGoonBBowersP, Leitz G and the 010 Study Group: Once-weekly epoetin alfa dosing is as effective as three times-weekly dosing in increasing hemoglobin levels and is associated with improved quality of life in anemic, HIV-infected patients. J. Acquir. Immune Defic. Syndr.34, 368–378 (2003).
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Large, prospective study that randomized patients to weekly versus three-times weekly erythropoietin. Study subjects included HIV-infected patients with hemoglobin counts less than 12 g/dl, without AIDS and receiving antiretroviral therapy.
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RevickiDABrownREHenryDH: Recombinant human erythropoietin and health-related quality of life in AIDS patients with anemia. J. Acquir. Immune Defic. Syndr.7, 474–484 (1994).
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BerhaneKKarimRCohenMH: Impact of highly active antiretroviral therapy on anemia and relationship between anemia and survival in a large cohort of HIV-infected women: Women's Interagency HIV Study. J. Acquir. Immune Defic. Syndr.37, 1245–1252 (2004).
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Data from the WIHS demonstrating the effect of highly active antiretroviral therapy (HAART) in correcting anemia and improving survival among HIV-infected women.
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VolberdingPALevineAMDieterichD: Anemia in HIV infection: clinical impact and evidence-based management strategies. Clin. Infect. Dis.38, 1454–1463 (2004).
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LutherJMLakeyDLLarsonRS: Utility of bone marrow biopsy for rapid diagnosis of febrile illnesses in patients with human immunodeficiency virus infection. South. Med. J.93, 692–697 (2000).
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SembaRDShahNVlahovD: Improvement of anemia among HIV-infected injection drug users receiving highly active antiretroviral therapy. J. Acquir. Immune Defic. Syndr.26, 315–319 (2001).
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One of the earliest studies to correlate correction of anemia with HAART use.
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MosesAVWilliamsSHeneveldML: Human immunodeficiency virus infection of bone marrow endothelium reduces induction of stromal hematopoietic growth factors. Blood87, 919–925 (1996).
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BahnerIKearnsKCoutinhoS: Infection of human marrow stroma by human immunodeficiency virus-1 (HIV-1) is both required and sufficienct for HIV-1-induced hematopoietic suppression in vitro: demonstration by gene modification of primary human stroma. Blood90, 1787–1798 (1997).
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BagnaraGPAzuliGGiovanniniM: Early loss of circulating hemopoietic progenitors in HIV-1-infected subjects. Exp. Hematol.18, 426–430 (1990).
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SpivakJLBarnesDCFuchsPAQuinnTC: Serum immunoreactive erythropoietin in HIV-infected patients. JAMA261, 3104–3107 (1989).
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SipsasNVKokoriSIIoannidisJP: Circulating autoantibodies to erythropoietin are associated with human immunodeficiency virus type 1-related anemia. J. Infect. Dis.180, 2044–2047 (1999).
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RemachaAFCadafachJ: Cobalamin deficiency in patients with the human immunodeficiency virus. Semin. Hematol.36, 75–87 (1999).
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ThompsonCEDamonLELiesCALinkerCA: Thrombotic microangiopathies in the 1980's: clinical features, response to treatment, and the impact of the human immunodeficiency virus epidemic. Blood80, 1890–1895 (1992).
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RarickMUEspinaBMocharnukR: Thrombotic thrombocytopenic purpura in patients with human immunodeficiency virus infection: a report of three cases and review of the literature. Am. J. Hematol.40, 103–109 (1992).
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SahudMAClasterSLiuL: Von-Willebrand factor cleaving protease inhibitor in a patient with human immunodeficiency virus-associated thrombotic thrombocytopenic purpura. Br. J. Haematol.116, 909–911 (2002).
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SaifMW: HIV-associated autoimmune hemolytic anemia: an update. AIDS Patient Care STDs15, 217–224 (2001).
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NunezMSorianoV: Management of patients coinfected with hepatitis B virus and HIV. Lancet Infect. Dis.5, 374–382 (2005).
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Informative overview of the management of patients with HIV and hepatitis B virus.
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SorianoVMaidaINunezM: Long-term follow-up of HIV-infected patients with chronic hepatitis C virus infection treated with interferon-based therapies. Antivir. Ther.9, 987–992 (2004).
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FrederickRTHassaneinTI: Role of growth factors in the treatment of patients with HIV/HCV coinfection and patients with recurrent hepatitis C following liver transplant. J. Clin. Gastroenterol.39(Suppl. 1), S14–S222005).
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FischlMGalpinJELevineJD: Recombinant human erythropoietin for patients with AIDS treated with zidovudine. N. Engl. J. Med.322, 1488–1493 (1990).
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First major publication supporting the role of erythropoietin in anemic HIV-infected patients with AIDS who were receiving zidovudine therapy.
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HenryDHBeallGNBensonCA: Recombinant human erythropoietin in the treatment of anemia associated with human immunodeficiency virus (HIV) infection and zidovudine therapy: overview of four clinical trials. Ann. Intern. Med.1992, 739–748 (2002).
