What Is Anemia?
Anemia is a condition in which the number of red blood cells (RBC's) or the amount of hemoglobin is decreased in the blood. Red blood cells and hemoglobin are responsible for carrying oxygen to vital organs throughout the body. Anemia is one of the most common blood abnormalities seen in people with HIV disease. The incidence of anemia ranges from 10% in people who have no symptoms to 92% in individuals with advanced AIDS (Kreuzer et al., 1999). The cause of anemia in people with HIV disease can be due to many factors. Some of those causes are:
- Normal progression of HIV disease. The virus can infect parts of the bone marrow responsible for manufacturing red blood cells.
- Deficiency of a hormone called Erythropoeitin which is required to stimulate red blood cell production.
- Opportunistic infections such as mycobacterial disease (MAC), or fungal diseases.
- Cancers of the bone marrow such as Non-hodgkins lymphoma.
- Nutritional deficiencies of malabsorption. This is the major source of anemia Vitamin B12 deficiency.
There are many medications that are used in treatment of HIV and AIDS that can also cause anemia. Combination therapy including as many as 3-5 drugs has become the standard of practice. Many of these medications can cause side effects such as anemia. The following drugs that are used to treat HIV and AIDS may also cause anemia.
- AZT (Combivir, Retrovir)
- Some chemotherapy used in the treatment of HIV related cancers.
How Do I Know if I Have Anemia?
Symptoms of anemia include fatigue, rapid heart beat, shortness of breath and lightheadedness. These symptoms are caused by the body attempting to deliver poorly oxygenated blood to all of the vital organs. Other symptoms of anemia include: coldness of the hands and feet, pale complexion, and pale lips.
How Does Anemia Affect People with HIV?
People with anemia often suffer decreased quality of life as well as potential increased chance of mortality. Several studies have been performed looking at the quality of life of people with HIV-related anemia. A large study of more than 1,200 people with HIV and cancer showed that low hemoglobin levels are associated with greater fatigue and a poor overall quality of life. The Centers for Disease Control conducted a large study reviewing medical records of HIV-infected patients from January, 1990 through August, 1996 (Sullivan et. al, 1998). This study concluded that the incidence of anemia was found to be strongly associated with progression of HIV disease. HIV-infected individuals with anemia were also found to have shorter survival rates. A study was performed at the Johns Hopkins University School of Medicine AIDS Clinic to assess the incidence of anemia in their patients. This study looked at a total of 2,348 patients of which 498 had developed anemia. The study showed that untreated anemia is associated with a greater risk of dying, regardless of T-Cell count, opportunistic infection or treatment with antiviral drugs.
What Can I Do About Anemia?
Anemia can be treated once the source is identified. A person with severe anemia must receive a blood transfusion, however, transfusions should not be relied upon as a chronic treatment of anemia due to the possible chance of transmission of other blood-borne agents. Most recently a new version of blood-borne hepatitis has been identified. In persons with Vitamin B12 deficiency replacement of that vitamin and dietary supplementation will usually treat the anemia effectively. In people with anemia due to HIV medications such as AZT, Procrit (Epoetin alfa) is quite effective in treating anemia. Patients can be given injections of 10,000 units three times a week. Currently studies are underway looking at weekly dosing of Procrit. Several studies have evaluated the effect of Procrit on the quality of life of HIV infected patients. A study by Dr. David Henry, et al., 1992, evaluated 255 patients half of whom received Epoetin alfa three times a week. The quality of life scores improved in the group that received Procrit, however, there were no differences in side effects between the group treated with Procrit and the group treated with Placebo (saline injection). Several other studies show a definite improvement in quality of life as well as decreased transfusion dependence, and correction of the anemia by using Procrit.
In conclusion, treatment of people with HIV disease and anemia collates with improved survival, as well as improved qualify of life and general sense of well being. It is important for the patient and the healthcare provider to work together in identifying the source of anemia. Primary care of people with HIV should include maximizing their quality of life. Today's aggressive therapies allow many people to resume a greater zest for life. Some of these medicines also come with side effects including anemia, which when adequately identified and treated has been proven to improve the quality of life for people with HIV.
About J. B. Molaghan, ANP, ACRN
Read answers to questions about HIV, fatigue and anemia