Recent studies have indicated that people living with HIV disease and their care providers should use extreme caution when approaching transfusions as treatment for anemia.

A new study links blood transfusions with increases in viral load.¹ Though the mechanism for this temporary rise in viral load is not yet known, this correlation of blood transfusions to viral load increase, coupled with previous studies, provide strong reason to reexamine the use of transfusions to treat HIV-related anemia.

Past studies have associated blood transfusions with higher rates of mortality for people with HIV disease who received transfusions versus those who did not receive transfusions. Information from these studies relates many complications from transfusions to the progression of HIV disease in spite of high CD 4 counts.² Transfusions also appear linked to increased risk of CMV, wasting, bacterial infections (e.g. MAI), reduced CD 4 and CD 8 ratios and overall length of survival.³

A large portion of people living with HIV disease develop anemia, and transfusions are a common therapy. Causes of HIV-related anemia include side effects from drugs (e.g. AZT, ganciclovir, and Bactrim), symptoms of opportunistic infections (e.g. MAC) and general HIV disease progression. However, there are few, if any, current protocols or standards of treatment regarding anemia.⁴

Further investigations into transfusion dangers for people living with HIV disease are under way. The National Heart, Lung and Blood Institute is initiating a Viral Activation Transfusion Study (VATS). Once completed, this study will clarify concerns about transfusions for people with HIV and help establish treatment protocols and standards of care for anemia.⁵

Concluding from current data, close monitoring of hemoglobin (Hb) counts and early treatment of the anemia with therapies such as erythropoietin (Procrit and Epogen) should be the priority. In addition, care providers should know their patientÕs risk for anemia as a result of therapies, opportunistic infections and other factors. The close monitoring of Hb counts and early treatment can prevent the severe drops in Hb levels that leave transfusions as the only treatment option.

Normal Hb counts should be 14-18 g/dL for men and 12-16 g/dL for women.

For more information on anemia or other treatment related questions, please contact NAPWA's Health and Treatment Department.

References

1. Mudido, P.M. et al. Human immunodeficiency virus type 1 activation after blood transfusion, Transfusion 1996; 36: 860-865.
2. Sloand, E. et al. Transfusion of blood components to persons infected with human immunodeficiency type 1, Transfusion 1994; 34: 48-53.
3. Ibid and Vamvakas and Kaplan, H.S. Early transfusion and length of survival in acquired immune deficiency syndrome, Transfusion 1993; 33: 111-118.
4. Sloand, E. et al. Transfusion of blood components to persons infected with human immunodeficiency type 1, Transfusion 1994; 34: 48-53.
5. Busch, M.P. et al. The Viral Activation Transfusion Study (VATS): rationale, objectives, and design overview, Transfusion 1996; 36: 854-859.

This article was provided by NAPWA, 1414 K Street, NW, Washington, DC 20005, 202/898-0414, 202/898-0435 (f), e-mail: napwa@napwa.org.