May 26, 1999
How does HIV cause aplastic anemia? Do infected cells produce certain proteins/toxins that can suppress the precursor cells in the bone marrow? Thank you
Response from Mr. Molaghan
Hello HIV causes anemia by a number of probable mechanisms. HIV becomes a "chronic disease" and the "anemia of chronic disease" mechanism gets set in motion where the body cannot utilize its iron stores to make hemoglobin. HIV is also a chronic viral infection and chronic virus infections also lead to anemia. The loss of T helper cells probably also decreases hematopoiesis. Increased productions of cytokines, especially in advanced disease, also likely block marrow production of red cells. Many of the drugs used to treat HIV or its infectious or malignant complications also suppress red cell production. Specific viruses, such as the rare parvovirus infection, can lead to red cell aplasia. Aplastic anemia, however, is a very rare complication of HIV. One of my physician colleagues, Dr. Donald Abrams, states "In 18 years of caring for patients with HIV, I have never seen a case of true aplastic anemia. Such a diagnosis requires severe anemia, neutropenia and thrombocytopenia with marked reduction in marrow precursors and fatty replacement." Many HIV patients with advanced disease may have pancytopenia, decrease in all elements, but not to a degree that constitutes aplasia. Again, drugs, chronic infection, depletion of T cell helper function and cytokines could be related to pancytopenia, as well as hypersplenism in patients with enlarged spleens. Aplastic anemia can follow viral infection, but hepatitis is a more common cause of aplasia than HIV.
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