New Mexico AIDS Infonet s5

AIDS InfoNet www.aidsinfonet.org Fact Sheet Number 552 ANEMIA WHAT IS ANEMIA? These approaches might not work. It may Anemia is a shortage of hemoglobin HIV infection can cause anemia. So can not be possible to stop using all (HGB). HGB is a protein in red blood many opportunistic infections (see fact medications that cause anemia. Two cells. It carries oxygen from the lungs to sheet 500) related to HIV disease. Many additional treatments are injections of the rest of the body. drugs commonly used to treat HIV and EPO and blood transfusions. related infections can cause anemia. Anemia causes fatigue, shortness of EPO (erythropoietin) stimulates the breath, and dizziness. People with production of red blood cells. In 1985, anemia don’t feel as good as people with scientists learned how to make synthetic a normal level of HGB. They find it ANEMIA AND HIV EPO. It is injected under the skin, usually harder to work. This is called having a Serious anemia used to be much more once a week. The most common brand lower quality of life. common. Over 80% of people with an of EPO is Procrit. In 2011 the FDA AIDS diagnosis had some degree of warned that using Procrit can increase HGB levels are measured as part of a anemia. People with more advanced HIV the risk for stroke, heart problems, and complete blood count (CBC). See Fact disease, or a lower CD4 count, had death. It recommended lower doses be Sheet 121 for more information on these higher rates of anemia. used in patients with chronic kidney laboratory tests. HGB is measured as disease. grams per deciliter, the amount in a The rate of anemia went down when specific sample of blood. people started using combination A large study of people with HIV found antiretroviral therapy (ART). Severe that EPO injections decreased the risk of Anemia is defined by the level of HGB. anemia has become rare. However, ART death. Transfusions seemed to increase Most health care providers agree that has not eliminated anemia. A large study the risk of death. Because of the risks of HGB levels below 6.5 indicate life- found that about 46% of patients had transfusions, they are rarely used to treat threatening anemia. Normal levels are at mild or moderate anemia, even after one anemia. least 12 for women and at least 14 for year of ART. men. Blood transfusion used to be the only Several factors are linked to a higher rate treatment for severe anemia. However, Overall, women have lower levels of of anemia in people with HIV: transfusions can cause infection and HGB. So do very old and very young  Lower CD4 cell counts (see fact sheet suppress the immune system. They people. More African-Americans have 124) appear to cause faster progression of anemia than people in other ethnic  Higher viral load (fact sheet 125) HIV disease and to increase the risk of death for HIV patients. groups.  Lower levels of vitamin D  Taking AZT (Retrovir, fact sheet 411)  Taking medications for hepatitis C (see fact sheet 680) WHAT CAUSES ANEMIA?  Being African-American THE BOTTOM LINE Anemia increases fatigue and makes The bone marrow produces red blood  Being a woman cells. This process requires iron, the people feel bad. It increases the risk of disease progression and death. It can be vitamins B12 and folic acid (or folate). HIV disease progression is about 5 times caused by HIV infection or other Erythropoietin (EPO) stimulates the more common in people with anemia. diseases. Many drugs used to treat HIV production of red blood cells. EPO is a Anemia is also linked to a higher risk of and related infections also cause hormone made by the kidneys. death. Treatment of anemia seems to anemia. eliminate these risks. Anemia can be caused by the body not making enough red blood cells. It is also Anemia has always been a problem for caused by their loss or destruction. people with HIV and AIDS. The rate of Several factors can cause anemia: serious anemia has dropped HOW IS ANEMIA TREATED? considerably since people started using  Too little iron, vitamin B12 or folate. A Treating anemia depends on its cause. shortage of folate can cause ART. However, almost half of people with  First, treat any chronic bleeding. megaloblastic anemia, where red HIV still have mild or moderate anemia. This could be internal bleeding, blood cells are large and pale (see hemorrhoids, or even frequent Fact Sheet 121). Treating anemia improves the health and nosebleeds.  Damage to bone marrow or kidneys. survival of people with HIV. Correcting  Next, correct any shortages of iron, bleeding or shortages of iron or vitamins  Blood loss from internal bleeding or a vitamin B12 or folate. are the first steps. If possible, woman’s menstrual cycle.  Stop using, or reduce the doses of medications that cause anemia should  Destruction of red blood cells medications that cause anemia. be stopped. If necessary, the patient (hemolytic anemia).

A Project of the International Association of Providers of AIDS Care. Fact Sheets can be downloaded from the Internet at http://www.aidsinfonet.org should be treated with erythropoietin, or, in rare cases, with a blood transfusion. Reviewed June 4, 2014

A Project of the International Association of Providers of AIDS Care. Fact Sheets can be downloaded from the Internet at http://www.aidsinfonet.org