Dr Young,

I keep reading about how those with HIV tend to be anemic. Obviously this leads to fatigue, but I have yet to hear when someone will become anemic. What causes this? Why would HIV lead someone to be anemic? How long in the diagnosis would anemia begin to set in and how would this be treated? Thanks Doctor

There are many causes of anemia in persons with HIV infection.

HIV itself can cause anemia- this usually occurs relatively late in the disease course, and mainly in persons with AIDS.

A number of HIV complications, such as M.avium or tuberculosis infections or lymphoma can cause the bone marrow to produce fewer red blood cells.

Lastly, some HIV antiretroviral medications (particularly ZDV) or medications commonly used in persons with HIV infection, such as Bactrim can cause varying degrees of anemia. Rarely, severe nutritional abnormalities (folate, vitamin B12 or iron) can cause anemia.

The treatment of anemia, of course, would depend on the cause. If possible the underlying cause is treated or removed (in the case of drugs). One would want to be sure that there was adequate iron intake. In moderately severe cases, red cell growth factor (erythropoetin) can be given to stimulate the production of red blood cells from the bone marrow. For severe, symptomatic cases, red blood cells can be transfused into the affected person.