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The Body Covers: The 1st International AIDS Society Conference on HIV Pathogenesis and Treatment
Cost Benefit and Outcomes of HAART

Coverage provided by Robert J. Frascino, M.D.

July 9, 2001

Click here to view the original abstract.


Introduction and Background

A growing body of evidence has shown that anemia is associated with a poorer prognosis in HIV disease. Other studies have suggested that recovery from anemia or correction of anemia with epoetin alpha is linked to improved survival. A key question is how the widespread use of highly active retroactive therapy (HAART) has affected the prevalence of anemia in HIV-positive individuals. Drs. Mildvan and Creagh, et al. undertook the present study because data on the frequency of anemia in U.S. patients in the era of HAART is limited. They designed a study to assess the prevalence of anemia in a large cross-section of U.S. patients seeking care for HIV/AIDS in the year 2000. This presentation is an interim analysis describing prevalence and associated risk factors for anemia in 4,183 patients (10,000 patients will ultimately be reviewed in the final analysis). This multi-center study collected and analyzed demographic, clinical, and laboratory data. Approximately 75% of the patients were on HAART.


Results

Women had an 80% greater risk of both anemia (hemoglobin less than 12 g/dL) and marked anemia (hemoglobin less than 10 g/dL). In addition, when compared to Caucasians, the relative risk of anemia was found to be significantly stronger (2.6 times stronger) for African Americans. The prevalence of anemia in this group of patients presenting for care in the year 2000 was 3% to 57%, depending upon the subgroup analyzed. The highest prevalence was seen in patients with CD4 counts less than 200 and African Americans. In general, anemia was more prevalent in HIV-positive women than HIV-positive men.


Discussion

The higher prevalence of anemia in HIV-positive women compared to HIV-positive men is similar to prevalence studies performed in the pre-HAART era. This higher prevalence in women may be partially explained by differences in gender physiology. Women have an increased propensity for anemia due to monthly blood loss from menstruation and a relative lack of testosterone compared to men. Testosterone can increase red blood cells by stimulating the production and release of erythropoietin in the kidney. Erythropoietin, in turn, increases red blood cell production in the bone marrow.

The higher prevalence of HIV-related anemia in African Americans compared to Caucasians was notable in this study. This increased risk associated with African American race has also been reported by Sullivan and colleagues in a very large retrospective study in the pre-HAART era. Reasons for this difference have not been fully elucidated. One possible contributing factor could be the anemia induced by glucose-6-phosphate dehydrogenase (G6PD) deficiency, which occurs more frequently among African Americans in whom the prevalence is between 3% and 13%.


Why Is This Study Important to Physicians?

In the era of HAART, anemia has been perceived by some clinicians as a less important clinical issue. This large multicenter study demonstrates that anemia, even in the era of HAART, continues to affect a substantial number of HIV-positive patients. Prevalence is increased in women compared to men, African Americans compared to Caucasians, and in those with CD4 cell counts less than 200. Anemia has been shown to have a negative impact on functional capacity and quality of life, and has been associated with shortened survival. Clinicians should consider not only quality of life decrement caused by anemia, but also the associated poorer prognosis (disease progression and increased mortality). Given the impact of anemia in HIV-positive patients coupled with the availability of safe and effective therapy, clinicians should be more vigilant in monitoring and treating HIV-related anemia.


Why Is This Study Important for Patients?

People living with HIV need to remember three key points related to anemia:
  1. Anemia is common in HIV disease, especially in women, African Americans, and those with low CD4 cell counts.

  2. Anemia is associated with a poorer prognosis (i.e., disease progression and increased mortality), even in patients currently on HAART. In addition, anemia has a deleterious effect on functional capacity, energy level, and quality of life.

  3. Recovery from anemia or correction of anemia with epoetin alpha is associated with increased energy level and functional capacity, enhanced quality of life, and improved survival.


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