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Fatigue and AnemiaFatigue and Anemia
           
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best anemia treatment
Jan 4, 2002

Hey Dr. Bob, You were right!!! I was low on hemoglobin. My doc who is nice enough but kinda way to busy told me if I wanted to treat it he would prescribe steroids. I told him I wanted to try the injectable stuff you talked about at your lecture here. He told me steroids were "easier". I have the prescription (for steroids) but haven't filled it yet. What do you think? My hemoglobin is down to 10.1 and I'm feeling wiped out. Read some of your recent responses on this site. You're the best -- Don't suppose you are taking applications for a life partner -- are you? I give great total body massages including a happy ending -- of course! X

Response from Dr. Frascino

Hey X,

I love it when the X-men write in. Now, let me get this straight: The "nice-enough-but-kinda-way-too-busy" doc graciously told you he would treat your anemia "if you wanted" with steroids rather than Procrit, because it was "easier?" Easier for whom? The answer is obviously easier for Dr. Way-Too-Busy. The real question should be what's best for you, X-man. It's gratifying to know you were paying attention to my lecture rather than just trying to ingest the usual rubber chicken in brown sauce dinner. The injectable "stuff" I was talking about is called Procrit. Procrit is identical to a substance your body produces naturally called "erythropoietin." Erythropoietin stimulates the production of new red blood cells in the bone marrow - the body's red blood cell factory. Increasing the red blood cell count will resolve your anemia problem. Correcting HIV-related anemia with Procrit has been shown to improve energy level and quality of life. It is also associated with improved survival. Procrit has an excellent track record when it comes to safety. I presently recommend the convenient once-per-week dosing schedule. Many folks find this once-per-week dose "easier" than taking more pills on a daily basis.

So what about "steroids?" Why even consider them for treatment of anemia?

Androgenic/anabolic steroids stimulate the production of erythropoietin. In addition, they increase the responsiveness of immature bone marrow cells to the effects of erythropoietin. In fact, hemoglobin levels are higher in men than in women because men have higher levels of androgens, including testosterone. However, it is important to note that Anadrol has not been studied in HIV-positive patients. HIV disease is becoming more of a chronic condition with life expectancy improving as a consequence of new and more potent antiretroviral agents. As a result, the long-term consequences of therapy are becoming more evident and important. Many anti-HIV drugs are metabolized in the liver. Oral androgenic/anabolic agents are inactivated by the liver and are associated with significant liver toxicities. Additional stress on the liver should be avoided whenever possible in patients on anti-HIV drug cocktails and/or those with hepatitis C co-infection. In addition, Anadrol, as well as the other anabolic agents, has significant masculinizing effects, often precluding their use in women or prepubertal children.

The bottom line is that even though Anadrol may increase hemoglobin levels, it does this at a significant risk of associated side effects. In addition to the significant liver toxicities noted above, anabolic agents are known to adversely alter cholesterol levels (decrease HDL and increase LDL). A significant number of patients on protease inhibitors and other HIV medications are already experiencing lipid abnormalities. Anabolic agents may further exacerbate these problems, thereby increasing the risk of atherosclerotic heart disease.

Anabolic agents certainly have their place in the treatment of HIV disease - particularly in the treatment of wasting and hypogonadism - but they should be used judiciously in light of their adverse consequences, drug interactions, and potential long-term complications. Certainly, if the therapeutic goal is to treat the patient's HIV-related anemia, Procrit is the treatment of choice, not only for efficacy, but also for safety. Clinical studies in HIV-infected individuals with anemia have demonstrated Procrit's efficacy. Procrit has no drug interactions or harmful effects on the liver or other critical organs, and can be used for as long as necessary without adverse consequences or side effects. It is safe for use in men, women, and children.

So from a "way-too-busy" physician's perspective, perhaps oral steroids are "easier," but from an anemic HIV-positive person's perspective, there really are some excellent reasons to favor Procrit.

Now, I bet this is way more information than you wanted, right? Well, we strive to be an information-oriented website, so in the interest of information, please tell us what do you mean by a "happy ending" to your total body massage??? Inquiring minds want to know.

Stay well. Happy New Year.

Dr. Bob


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