• Relationship between highly active anti-retroviral therapy (HAART), anemia and survival in a large cohort of HIV-infected women (Women's Interagency HIV Study -- WIHS) (MoPeB2180 Poster Exhibition)
  Authored by A. Levine, K. Berhane, M.N. Sanchez, L. Masri-Levine, L. Pearce, M. Cohen, M. Young, M. Newman, K. Anastos, M. Augenbraun, S. Gange, D. Burns (United States)

• Leukocyte-reduction of red blood cells (RBC) does not improve clinical outcome in anemic patients with advanced HIV infection needing RBC transfusion (MoPeB2143) Authored by A. Collier, L. Kalish, M. Bush, T. Gernsheimer, S. Assmann (United States)

Two of today's posters dealt with issues related to anemia (low red blood count) in persons with HIV. Anemia is important in HIV, since it is common, especially with advanced HIV/AIDS, and has been associated with shorter survival. Both these studies were done in the United States.

Women's Interagency HIV Study (WIHS)

Data from this study of over 2,000 women with HIV described relationships between anemia, antiretroviral therapy and survival (Levine et al, MoPeB2180). Most of these new data support results from previous studies in men and smaller studies in women. The women in this study who had anemia were more likely to have advanced HIV (CD4 cell counts less than 200 cells/mm³, higher viral loads, and an AIDS diagnosis), were more likely to be black, use AZT, and have smaller red blood cells (a low MCV). (It is known that AZT can cause anemia.)

The bad (but expected) news from this study was that women who developed anemia or who had persistent anemia were more likely to die. The good news from this study is that women with anemia who started (and stayed on) potent antiretroviral therapy and had increases in CD4 cell counts were more likely to have increases in their red blood counts (have their anemia improve). Antiretroviral therapy also helped protect against the development of anemia. This is additional information relevant to decision-making about use of antiretroviral therapy.

Viral Activation Transfusion Study (VATS)

Another study looked at the effects of red blood cell (RBC) transfusions in patients with HIV and anemia who were having a first transfusion (Collier et al, MoPeB2143). (The patients in this study also had cytomegalovirus (CMV), a common co-infection.) Previous studies suggested that blood transfusions might activate or suppress the immune system, increase plasma HIV RNA, and worsen the course of HIV. These effects have been linked to white blood cells that are contained in RBC transfusions.

The VATS study was a double-blind, randomized study that compared use of filtered RBCs to routinely prepared RBCs in 531 persons with advanced HIV. (Filtering RBCs decreases white blood cells in RBC transfusions.) The main results were similar outcomes in both groups with respect to survival, development of serious AIDS illnesses, plasma HIV viral load, plasma CMV viral load, and CD4+ cells over time. These data suggest there is no need to use filtered RBCs in persons with HIV.