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AIDS InfoNet
Fact Sheet Number 552
HIV infection can cause anemia. So medications that cause anemia. Two
Anemia is a shortage of hemoglobin can many opportunistic infections (see
additional treatments are transfusions,
(HGB). HGB is a protein in red blood
fact sheet 500) related to HIV disease.
and injections of EPO.
cells. It carries oxygen from the lungs
Many drugs that are commonly used to

to the rest of the body.
treat HIV and related infections can Blood transfusion used to be the only

cause anemia.
treatment for severe anemia. However,
Anemia causes fatigue and shortness
transfusions can cause infection and
of breath. People with anemia don’t
suppress the immune system. They
feel as good as people with a normal
appear to cause faster progression of
level of HGB. They find it harder to Serious anemia used to be much more
HIV disease and to increase the risk of
work. This is called having a lower common. Over 80% of people with an
death for HIV patients.
quality of life.
AIDS diagnosis had some degree of

anemia. People with more advanced EPO (erythropoietin) stimulates the
HGB levels are measured as part of a
HIV disease, or a lower CD4 count, had
production of red blood cells. In 1985,
complete blood count (CBC.) See Fact
higher rates of anemia.
scientists learned how to make
Sheet 106 for more information on
synthetic EPO. It is injected under the
these laboratory tests. HGB is The rate of anemia went down when skin, usually once a week.
measured as grams per deciliter, the people started using highly active
amount in a specific volume of blood.
antiviral therapy (HAART.) Severe A large study of people with HIV found

anemia has become rare. However, that transfusions seemed to increase
Anemia is defined by the level of HGB. HAART has not eliminated anemia. A
the risk of death, while EPO injections
Most doctors agree that HGB levels large study found that about 46% of decreased it. Because of the risks of
below 6.5 indicate life-threatening patients had mild or moderate anemia,
transfusions, they are rarely used to
anemia. Normal levels are at least 12
even after one year of HAART.
treat anemia.
for women and at least 14 for men.

Several factors are linked to a higher
Overall, women have lower levels of rate of anemia in people with HIV:
HGB. So do very old and very young
• Lower CD4 cell counts (see fact Anemia has always been a problem for
people. More African-Americans have
sheet 412).
people with HIV and AIDS. The rate of
anemia than people in other ethnic • Higher viral load (fact sheet 413)
serious anemia has dropped
• Taking AZT (Retrovir, fact sheet considerably since people started using

HAART. However, almost half of

• Being
people with HIV still have mild or
• Being a woman
moderate anemia.
The bone marrow produces red blood

cells. This process requires iron, the HIV disease progression is about 5 Anemia increases fatigue and makes
vitamins B
people feel bad. It increases the risk of
12 and folic acid (or folate.)
times more common in people with
Erythropoietin (EPO) stimulates the anemia. Anemia is also linked to a disease progression and death. It can
production of red blood cells. EPO is a
higher risk of death. Treatment of be caused by HIV infection or other
hormone made by the kidneys.
anemia seems to eliminate these risks.
diseases. Many drugs used to treat

HIV and related infections also cause
Anemia can be caused by low

production of red blood cells. It is also

caused by their loss or destruction.
Treating anemia improves the health
Treating anemia depends on its cause.
Several factors can cause anemia:
and survival of people with HIV.

• First, treat any chronic bleeding.
Too little iron, vitamin B
Correcting bleeding or shortages of
12 or folate.
This could be internal bleeding,
A shortage of folate can cause
iron, or vitamins are the first steps. If
hemorrhoids, or even frequent
megaloblastic anemia with large,
possible, medications that cause
pale red blood cells (see Fact Sheet
anemia should be stopped. If
• Next, correct any shortages of iron,
necessary, the patient should be

vitamin B
Damage to bone marrow or kidneys
12 or folate.
treated with erythropoietin, or, in rare

• Stop using, or reduce the doses of
Blood loss from internal bleeding or
cases, with a blood transfusion.
medications that cause anemia.
a woman’s menstrual cycle

Destruction of red blood cells These approaches might not work. It
(hemolytic anemia)
may not be possible to stop using all
Revised March 15, 2002

Partially funded by the National Library of Medicine and the New Mexico Department of Health
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