Dr. Bob, I know that one of the largest populations with of HIV-positives with anemia is African-Americans. How much does sickle cell disease play a role in this? Since sickle cell disease is a form of anemia in and of itself, is testing for SCD routine with HIV patients? Or do you think the HIV itself causes the anemia (not the SCD)? Or do the antiretrovirals cause anemia?

Thanks for taking your time to help me out.

Hi,

Sickle cell anemia is a hereditary condition caused by inheriting the sickle cell gene from both parents. It is seen primarily in black persons of African origin. The onset of symptoms is usually between 9-12 months of age and quite easily diagnosed with the proper blood tests. This is quite different from HIV-associated anemias, although I suppose it is possible for both conditions to co-exist in some very unlucky child.

The causes of anemia in the setting of HIV disease include:

1. Anemia of Chronic Disease - a chronic condition like cancer or HIV induces this condition. 2. Medication Side Effects - AZT, Bactrim, ganciclovir, dapsone, pyrimethamine, interferon, cancer chemotherapy, etc. 3. Opportunistic infections - mycobacterium avium complex (MAC), TB, CMV, Parvovirus B19.

Other common causes of anemia are bleeding, blood loss, vitamin deficiency, and iron deficiency.

To answer your final question, no, all antivirals do not cause anemia. Every drug has its own side effect and toxicity profile.

You're welcome. Hope that helps.

Dr. Bob