Advertisement

Prevalence and outcomes of anemia in individuals with human immunodeficiency virus: a systematic review of the literature

  • Pamela S Belperio
    Affiliations
    Infectious Diseases Section, Department of Research and Development, the Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA (PSB, DCR)
    Search for articles by this author
  • David C Rhew
    Correspondence
    Requests for reprints should be addressed to David C. Rhew, MD, Zynx Health, 9100 Wilshire Boulevard, East Tower, Suite 655, Beverly Hills, California 90212, USA.
    Affiliations
    Infectious Diseases Section, Department of Research and Development, the Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA (PSB, DCR)

    Zynx Health, Beverly Hills, California, USA (DCR)
    Search for articles by this author

      Abstract

      In patients with human immunodeficiency virus (HIV), anemia is a commonly encountered hematologic abnormality that has a significant impact on clinical outcomes and quality of life (QOL). This review describes the prevalence of anemia in several populations of patients with HIV and the effects of anemia on survival, morbidity, disease progression, transfusion requirements, and QOL. The prevalence of anemia in HIV disease varies considerably, ranging from 1.3% to 95%: it depends on several factors, including the stage of HIV disease, sex, age, pregnancy status, and injection-drug use as well as the definition of anemia used. In general, as HIV disease progresses, the prevalence and severity of anemia increase. Anemia is also more prevalent in HIV-positive women, children, and injection-drug users than in HIV-negative women, children, and injection-drug users. Anemia has been shown to be a statistically significant predictor of progression to the acquired immunodeficiency syndrome and is independently associated with an increased risk of death in patients with HIV. Treatment of anemia with epoetin-α has resulted in significantly fewer patients requiring transfusion as well as decreases in the mean number of units of blood transfused. Resolution of HIV-related anemia has been shown to improve QOL, physical functioning, energy, and fatigue in individuals with HIV. More recently, the use of highly active antiretroviral therapy has also been associated with a significant increase in hemoglobin concentrations and a decrease in the prevalence of anemia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sullivan P.S.
        • Hanson D.L.
        • Chu S.Y.
        • Jones J.L.
        • Ward J.W.
        • Adult/Adolescent Spectrum of Disease Group
        Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons.
        Blood. 1998; 91: 301-308
        • Saah A.J.
        • Hoover D.R.
        • He Y.
        • Kingsley L.A.
        • Phair J.P.
        Factors influencing survival after AIDS.
        J Acquir Immune Defic Syndr. 1994; 7: 287-295
        • Mocroft A.
        • Kirk O.
        • Barton S.E.
        • et al.
        • EuroSIDA Study Group
        Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe.
        AIDS. 1999; 13: 943-950
        • Moore R.D.
        • Keruly J.C.
        • Chaisson R.E.
        Anemia and survival in HIV infection.
        J Acquir Immune Defic Syndr Hum Retrovirol. 1998; 19: 29-33
        • Volberding P.A.
        • Lagakos S.W.
        • Koch M.A.
        • et al.
        • AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases
        Zidovudine in asymptomatic human immunodeficiency virus infection.
        N Engl J Med. 1990; 322: 941-949
        • Abrams D.I.
        • Steinhart C.
        • Frascino R.
        Epoetin alfa therapy for anaemia in HIV-infected patients.
        Int J STD AIDS. 2000; 11: 659-665
        • Revicki D.A.
        • Brown R.E.
        • Henry D.H.
        • McNeill M.V.
        • Rios A.
        • Watson T.
        Recombinant human erythropoietin and health-related quality of life of AIDS patients with anemia.
        J Acquir Immune Defic Syndr. 1994; 7: 474-484
        • Henry D.H.
        • Beall G.N.
        • Benson C.A.
        • et al.
        Recombinant human erythropoietin in the treatment of anemia associated with human immunodeficiency virus (HIV) infection and zidovudine therapy.
        Ann Intern Med. 1992; 117: 739-748
        • Moore R.D.
        • Creagh-Kirk T.
        • Keruly J.
        • et al.
        • Zidovudine Epidemiology Study Group
        Long-term safety and efficacy of zidovudine in patients with advanced human immunodeficiency virus disease.
        Arch Intern Med. 1991; 151: 981-986
        • Frontiera M.
        • Myers A.M.
        Peripheral blood and bone marrow abnormalities in the acquired immunodeficiency syndrome.
        West J Med. 1987; 147: 157-160
        • Barroso J.
        A review of fatigue in people with HIV infection.
        J Assoc Nurses AIDS Care. 1999; 10: 42-49
        • Breitbart W.
        • McDonald M.V.
        • Rosenfeld B.
        • Monkman N.D.
        • Passik S.
        Fatigue in ambulatory AIDS patients.
        J Pain Symptom Manage. 1998; 15: 159-167
        • Cosby C.
        • Holzemer W.L.
        • Henry S.B.
        • Portillo C.J.
        Hematological complications and quality of life in hospitalized AIDS patients.
        AIDS Patient Care STDS. 2000; 14: 269-279
        • Patton L.L.
        Hematologic abnormalities among HIV-infected patients.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 561-567
        • Keller M.J.
        • Hausdorff J.M.
        • Kyne L.
        • Wei J.Y.
        Is age a negative prognostic indicator in HIV infection or AIDS?.
        Aging (Milano). 1999; 11: 35-38
        • Turner B.J.
        • Markson L.
        • Taroni F.
        Estimation of survival after AIDS diagnosis.
        J Clin Epidemiol. 1996; 49: 59-65
        • Kozak L.J.
        • McCarthy E.
        • Moien M.
        Patterns of hospital use by patients with diagnoses related to HIV infection.
        Public Health Rep. 1993; 108: 571-581
        • Moore R.D.
        • Keruly J.
        • Richman D.D.
        • Creagh-Kirk T.
        • Chaisson R.E.
        • Zidovudine Epidemiology Study Group
        Natural history of advanced HIV disease in patients treated with zidovudine.
        AIDS. 1992; 6: 671-677
        • Mir N.
        • Costello C.
        • Luckit J.
        • Lindley R.
        HIV-disease and bone marrow changes.
        Eur J Haematol. 1989; 42: 339-343
        • Raal F.J.
        • Wypkema E.M.
        • Baynes R.D.
        Haematological abnormalities in the acquired immunodeficiency syndrome.
        S Afr Med J. 1988; 74: 157-160
        • Zon L.I.
        • Arkin C.
        • Groopman J.E.
        Haematologic manifestations of the human immune deficiency virus (HIV).
        Br J Haematol. 1987; 66: 251-256
        • Treacy M.
        • Lai L.
        • Costello C.
        • Clark A.
        Peripheral blood and bone marrow abnormalities in patients with HIV related disease.
        Br J Haematol. 1987; 65: 289-294
        • Antelman G.
        • Msamanga G.I.
        • Spiegelman D.
        • et al.
        Nutritional factors and infectious disease contribute to anemia among pregnant women with human immunodeficiency virus in Tanzania.
        J Nutr. 2000; 130: 1950-1957
        • Meda N.
        • Dao B.
        • Ouangre A.
        • DITRAME Study Group
        HIV, maternal anemia and perinatal intervention using zidovudine.
        Int J Gynaecol Obstet. 1998; 61: 65-66
        • Ramon R.
        • Sawadogo D.
        • Koko F.S.
        • et al.
        Haematological characteristics and HIV status of pregnant women in Abidjan, Cote d'Ivoire, 1995-96.
        Trans R Soc Trop Med Hyg. 1999; 93: 419-422
        • Bucceri A.
        • Luchini L.
        • Rancilio L.
        • et al.
        Pregnancy outcome among HIV positive and negative intravenous drug users.
        Eur J Obstet Gynecol Reprod Biol. 1997; 72: 169-174
        • Semba R.D.
        • Shah N.
        • Klein R.S.
        • et al.
        Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus-infected and -uninfected women.
        Clin Infect Dis. 2002; 34: 260-266
      1. Levine AM, Berhane K, Masri-Lavine L, et al. Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women's Interagency HIV Study. J Acquir Immune Defic Syndr. 2001;26:28–35

        • van der Werf M.J.
        • van Benthem B.H.
        • van Ameijden E.J.
        Prevalence, incidence and risk factors of anaemia in HIV-infected and HIV-negative drug users.
        Addiction. 2000; 95: 383-392
        • Semba R.D.
        • Shah N.
        • Vlahov D.
        Improvement of anemia among HIV-infected injection drug users receiving highly active antiretroviral therapy.
        J Acquir Immune Defic Syndr. 2001; 26 ([published erratum in J Acquir Immune Defic Syndr. 2002;30:462]): 315-319
        • Yoong K.Y.
        • Cheong I.
        A study of Malaysian drug addicts with human immunodeficiency virus infection.
        Int J STD AIDS. 1997; 8: 118-123
        • Semba R.D.
        • Shah N.
        • Vlahov D.
        Risk factors and cumulative incidence of anaemia among HIV-infected injection drug users.
        Int J STD AIDS. 2002; 13: 119-123
        • Semba R.D.
        • Shah N.
        • Strathdee S.A.
        • Vlahov D.
        High prevalence of iron deficiency and anemia among female injection drug users with and without HIV infection.
        J Acquir Immune Defic Syndr. 2002; 29: 142-144
        • Vlahov D.
        • Anthony J.C.
        • Munoz A.
        • et al.
        The ALIVE study: a longitudinal study of HIV-1 infection in intravenous drug users: description of methods.
        J Drug Issues. 1991; 21: 759-776
        • Adewuyi J.
        • Chitsike I.
        Haematologic features of the human immunodeficiency virus (HIV) infection in black children in Harare.
        Cent Afr J Med. 1994; 40: 333-336
        • Shaffer N.
        • Hedberg K.
        • Davachi F.
        • et al.
        Trends and risk factors for HIV-1 seropositivity among outpatient children, Kinshasa, Zaire.
        AIDS. 1990; 4: 1231-1236
        • Ellaurie M.
        • Burns E.R.
        • Rubinstein A.
        Hematologic manifestations in pediatric HIV infection.
        Am J Pediatr Hematol Oncol. 1990; 12: 449-453
        • Totin D.
        • Ndugwa C.
        • Mmiro F.
        • Perry R.T.
        • Jackson J.B.
        • Semba R.D.
        Iron deficiency anemia is highly prevalent among human immunodeficiency virus-infected and uninfected infants in Uganda.
        J Nutr. 2002; 132: 423-429
        • Eley B.S.
        • Sive A.A.
        • Shuttleworth M.
        • Hussey G.D.
        A prospective, cross-sectional study of anaemia and peripheral iron status in antiretroviral naive, HIV-1 infected children in Cape Town, South Africa.
        BMC Infect Dis. 2002; 2: 3
        • Horsburgh Jr, C.R.
        • Metchock B.
        • Gordon S.M.
        • Havlik J.A.
        • McGowan J.E.
        • Thompson S.E.
        Predictors of survival in patients with AIDS and disseminated Mycobacterium avium complex disease.
        J Infect Dis. 1994; 170: 573-577
        • Graham N.M.
        • Piantadosi S.
        • Park L.P.
        • Phair J.P.
        • Rinaldo C.R.
        • Fahey J.L.
        CD4+ lymphocyte response to zidovudine as a predictor of AIDS-free time and survival time.
        J Acquir Immune Defic Syndr. 1993; 6: 1258-1266
        • Swanson C.E.
        • Tindall B.
        • Cooper D.A.
        • Australian Zidovudine Study Group
        Efficacy of zidovudine treatment in homosexual men with AIDS-related complex.
        AIDS. 1994; 8: 625-634
        • Sathe S.S.
        • Gascon P.
        • Lo W.
        • Pinto R.
        • Reichman L.B.
        Severe anemia is an important negative predictor for survival with disseminated Mycobacterium avium-intracellulare in acquired immunodeficiency syndrome.
        Am Rev Respir Dis. 1990; 142: 1306-1312
        • Justice A.C.
        • Feinstein A.R.
        • Wells C.K.
        An effective new prognostic staging system for AIDS.
        Trans Assoc Am Physicians. 1988; 101: 18-23
        • Wenger J.D.
        • Whalen C.C.
        • Lederman M.M.
        • et al.
        Prognostic factors in acquired immunodeficiency syndrome.
        J Gen Intern Med. 1988; 3: 464-470
        • Creagh-Kirk T.
        • Doi P.
        • Andrews E.
        • et al.
        Survival experience among patients with AIDS receiving zidovudine.
        JAMA. 1988; 260: 3009-3015
        • Balfour Jr, H.H.
        Recombinant human erythropoietin for the treatment of anemia in persons with AIDS not receiving zidovudine.
        Int J Antimicrob Agents. 1997; 8: 189-192
        • Buchanan R.J.
        • Wang S.
        • Huang C.
        Nursing home residents with HIV and anemia.
        AIDS Patient Care STDS. 2001; 15: 373-383
        • Steinberg J.P.
        • Spear J.B.
        • Murphy R.L.
        • et al.
        Predictors of outcome in AIDS patients receiving zidovudine.
        J Acquir Immune Defic Syndr. 1989; 2: 229-234
        • Morfeldt-Manson L.
        • Bottiger B.
        • Nilsson B.
        • von Stedingk L.V.
        Clinical signs and laboratory markers in predicting progression to AIDS in HIV-1 infected patients.
        Scand J Infect Dis. 1991; 23: 443-449
        • Wilson I.B.
        • Cleary P.D.
        Clinical predictors of functioning in persons with acquired immunodeficiency syndrome.
        Med Care. 1996; 34: 610-623
        • Semba R.D.
        • Shah N.
        • Klein R.S.
        • et al.
        • HER (Human Immunodeficiency Virus Epidemiology Research) Study Group
        Highly active antiretroviral therapy associated with improved anemia among HIV-infected women.
        AIDS Patient Care STDS. 2001; 15: 473-480
        • Moore R.D.
        • Forney D.
        Anemia in HIV-infected patients receiving highly active antiretroviral therapy.
        J Acquir Immune Defic Syndr. 2002; 29: 54-57
        • McArthur J.C.
        • Hoover D.R.
        • Bacellar H.
        • et al.
        • Multicenter AIDS Cohort Study
        Dementia in AIDS patients.
        Neurology. 1993; 43: 2245-2252