Anemia in HIV-infected adults: epidemiology, pathogenesis, and clinical management

Anemia is the most common cytopenia seen in people with HIV. Independent of CD4 count and HIV-viral load, anemia has been shown to correlate with increased mortality. Furthermore, successful treatment of anemia has been shown to reduce this risk of death in a comparison with patients with similar immunologic and virologic parameters who are not treated. Women, blacks, injection drug users, and people with advanced disease suffer disproportionally from anemia and should be screened. The pathogenesis of anemia in HIV is complex and may result from opportunistic infections, nutritional deficiencies, AIDS-associated malignancies, medications, or alteration in hematopoeisis induced by HIV itself. A careful review of the patient's past medical history, medications, symptoms, and basic laboratory studies often leads to a treatable cause(s). For patients without secondary causes of anemia, a combination of highly active antiretroviral therapy (HAART) and supplemental erythropoietin leads to improved outcomes. Given the importance of completing therapy on adequate doses of both interferon and ribavirin, effective management of anemia in HIV/Hepatitis C (HCV)-coinfected patients is particularly important.