October 27, 2001
In the early days of the HIV epidemic, anemia was a huge problem. First it was due to advanced HIV and then it was related to AZT. Since we have been using lower doses of AZT, it is seen less commonly, but is not any less important. From the cancer literature it became clear that quality of life declined dramatically when a patient's hemoglobin level fell below 12. That fact was often not clear to us in the trenches and we let the anemia get much lower. Then, it also became obvious that survival of patients with HIV was impacted by hemoglobins below 12 and that gave a real impetus to keep the anemia treated with epoetin alfa (Procrit). The dosage then was 10,000 units three times a week, which was somewhat inconvenient for patients (although there were no side effects associated with the drug). Gradually it was learned that once-weekly dosing was just as effective as three times per week and this study examines that dose.
Epoetin alfa (Procrit) is a study drug that is near and dear to my heart. We have been using it for ribavirin-induced anemia in hepatitis C-infected patients and it works very well. This study from Alabama suggests something that most of us who have ever used the drug already knew: It raises hemoglobin very well and abolishes the symptoms of anemia. That is well known and has been shown before. This study concentrated on the quality of life of people taking epoetin alfa. Generally, QOL is divided into several self-explanatory categories: physical function, energy and fatigue. All of these factors increased significantly with epoetin alfa use. This means that patients felt substantially better and probably, extrapolating from the older study, will have a longer survival. There was also a significant drop in transfusion requirements. Epoetin alfa has virtually no side effects and is used by injection once weekly. For anemia there is no reason not to use epoetin alfa that I can think of -- it is an ideal pharmaceutical product!