[MOL] Series [01125] Medicine On Line


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Anemia and HIV in the Era of Highly Active Antiretroviral Therapy

While results from clinical studies are indicating the importance of anemia and fatigue in the cancer patient, similar data are being collected in the HIV population. Dr. Moore reviewed the prevalence of anemia in HIV-positive subjects and its impact on quality of life, beginning to explore a putative relationship between extent anemia and overall survival.[24]

As in cancer patients, the mechanisms of anemia associated with HIV infection are numerous. Decreased red blood cell production may occur as a direct consequence of the HIV infection, of neoplasm infiltrating bone marrow, infections of bone marrow, nutritional deficiencies, and drug therapy. Increased red blood cell destruction is seen in the setting of Coombs positive hemolytic anemias, thrombotic purpura and disseminated intravascular coagulation, as well as blood loss. Importantly, the clinical stage of disease is correlated with the development of anemia.[25] In analyzing data from more than 13,000 HIV patients, the incidence of anemia was found to increase from 3.2% in seropositive individuals to 12.1% in subjects with signs of immunologic damage and to 36.9% for those with clinical evidence of AIDS. >From a quantitative point of view, only 10% of patients with clinical AIDS showed an hemoglobin level greater than 12 g/dL, with 50% of the patients with a level of 10 to 12 g/dL, and the remaining 40% with less than 10 g/dL (Figure 10). The data shown here were obtained in HIV-infected men, but similar proportions were also seen in HIV-infected women. In Dr. Moore's experience from Johns Hopkins, the incidence of anemia also increases as the CD4 cell count declines, from 7.3% for patients with a CD4 cell count greater than 200/mcL, to 20.7% for those with 100 to 200/mcL, up to 30.2% for those with a CD4 cell count less than 100/ mcL.

Figure 10. Hemoglobin levels in men at different stages of HIV infection.


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