Heamoglobin levels in hiv positive children-

Metrics details. HIV and anaemia are major health challenges in Africa. This study aimed at determining the severity and types of anaemia among HIV infected children and its effect on short term response to antiretroviral therapy ART. Microcytic-hypochromic anaemia However, the difference in clinical and immunological response between the anaemic and non-anaemic patients did not reach statistical significance.

Heamoglobin levels in hiv positive children

Heamoglobin levels in hiv positive children

Heamoglobin levels in hiv positive children

Vitamin B 12 malabsorption in patients with acquired Heamoglobin levels in hiv positive children syndrome. Patients received the standard of care, including free ART and management of anaemia according to standard protocol. Prevalence of anemia in children months old in the state of Pernambuco, Brazil. J Infect Dis. This is because the bioavailability of cow milk is less than human milk. Firstly, the exact causes of anaemia in these Erotic enema strories nurses were not determined. A causal relationship should not be inferred about the association between anaemia and Heamoglobin levels in hiv positive children response, however using our multiple regression analysis, anemia remained a significant predictor of virological response. We thank Muna Abdela for helping with data entry. Children who initially were reported with severe anemia had reduced to 1.

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Hemolytic anemia may result from RBC autoantibodies, hemophagocytic syndrome, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, or glucosephosphate dehydrogenase deficiency [ 36—11 ]. Christian Obirikorang: moc. Read this next. After obtaining consent, demographic questionnaires were completed. There have been suggestions Heamoglobin levels in hiv positive children increases in haemoglobin are predictive of treatment success [ 20 ]. The Anemia Prevalence Study Group. Google Preview. You can do a lot of prep work to make the perfect sleep environment. Causes of Hemoglobinuria By Kalli Harrison. Open in a separate window. Doctors often order this test for people with diabetes. View Metrics. One hundred sex, age-matched and healthy HIV-seronegative Heamoglobin levels in hiv positive children were used as control subjects. Determination of whether a cause-and-effect relationship exists between correction of anemia and improved survival is an important area for future research. If your take on meditation is that it's boring or too "new age," then read this.

Anemia and growth retardation are common manifestations of HIV-positive children, which threaten their lives.

  • Anaemia is a frequent complication of infection with the human immunodeficiency virus HIV and may have multiple causes.
  • Paul A.
  • Help someone with useful health advice.

Children, especially infants, are highly vulnerable to iron-deficiency anemia because of their rapid growth of the brain and the rest of the body. The objectives of this study were to compare the prevalence of iron-deficiency anemia in infants born from HIV-positive mothers and HIV-negative mothers and to identify the determinants of iron-deficiency anemia in infants. A comparative cross-sectional study was conducted in Bahir Dar city. Simple random sampling technique was used to select the study participants.

Mothers were interviewed; blood samples were collected from mothers and infants to measure the hemoglobin level and anthropometric indicators were obtained from the infants using world health organization standards. Descriptive statistics were used to estimate the prevalence of infantile anemia.

Binary logistic regression and multiple linear regressions were used to identify the determinants of infant anemia. Red blood cells are one of the formed elements of blood and they perform transportation of nutrients and waste products. Iron-deficiency anemia in early childhood has numerous effects that are nonreversible at later age.

Anemia in infancy can lead to impairment in brain development, delay in brain maturation, thereby reducing the cognitive function of the child, decrease in the growth of the child, and increase in the risk of infection because of its effect on immunity. Information regarding infantile anemia was scarce and this led to failure to plan effective anemia prevention in infants.

Many children suffer from irreversible harm because of improper anemia prevention activities during their infancy period. This study will fill these gaps and will alert decision makers to prioritize infantile anemia prevention and control intervention.

The city contains 10 governmental health centers. Mothers who were unable to communicate, absent during house-to-house visit, and of unknown HIV status were excluded from the study.

Simple random sampling technique was used to select these infants. Study participants were traced from the community based on the address written in the PMTCT log book.

The data were collected from January to June Mothers were interviewed and blood samples were collected both from the mothers and infants to measure the hemoglobin level. Length and weight of the infant were measured using world health organization WHO standards. An infant was gently placed on the recumbent board; we have assured that the infant was looking up and that the head, body, and toes were in a straight line; legs held together, with the other hand, slide the footboard against the infants feet until the heels of both feet touch the footboard with toes pointed upward; measurement was taken to the nearest 0.

The digital weight scale was used to measure the weight of each infant and weight was measured to the nearest 0. For the interview part, first the questionnaire was prepared in English then translated to Amharic language and then back to English to keep its consistency. The interview was conducted by 17 nurse professionals and supervised by 6 health officers.

The blood sample was collected by 9 laboratory technologists and close supervision was conducted by 4 second degree holder medical microbiologist. One milliliter mL blood sample was collected from each mother and infant following standard operational procedures to measure the hemoglobin level of mother and infant using the Mindray hematology analyzer.

To maintain the quality of the data, pretest was conducted in 50 mothers, training was given for data collectors and supervisors, and the whole data collection process was closely supervised. The collected data were checked for completeness. Permission was obtained from the respective authorities. Written informed consent was obtained from each mother. The confidentiality of the data was kept at all steps.

Study participants having the right to withdraw from the study at any point was respected. Infants or mothers with low hemoglobin counts were referred to the nearby health center for further management.

The mean age of infants in this group was 8. The mean maternal hemoglobin count was The prevalence of iron-deficiency anemia among infants born from HIV-negative mothers was A total of infants were included for a response rate of The mean age of infants born from HIV-positive mothers was 8. The prevalence of iron-deficiency anemia among infant born from HIV-positive mothers was The mean age of the infants was 8.

This result was higher than those from Montreal, Estonia, and Sweden, [ 23 , 24 , 34 ] similar to those from Nepal, [ 27 , 36 ] and lower than those from Indonesia. The odds of anemia for infants born from HIV-positive mothers were 2. This finding agrees with those from Zimbabwe and Indonesia. Stunted infants had 3. This finding agrees with those from Mexico. Infants born from low-income family had 2. This finding agrees with those from Indonesia and Kenya. Infants born from malaria-infected mother during pregnancy had 1.

This finding agrees with those from other parts of the world. Infants who used cow milk before 6 months had 1. This is because the bioavailability of cow milk is less than human milk. Infants who had a history of cough or fever 7 days preceding the survey had 2. This finding agrees with those from Zimbabwe. The hemoglobin of infant is directly related to the hemoglobin of mother.

This signals that intervention against maternal anemia also benefits in fighting infantile anemia. This result agrees with those from other parts of the world. This finding agrees with those from Indonesia, Mexico, and Ethiopia.

The hemoglobin counts of infants were negatively associated with family size. This finding agrees with finding from Indonesia. This research was implemented on a representative sample of infants born from HIV-positive and HIV-negative mothers so can be generalized safely to the population of infants born from HIV-positive and HIV-negative mothers to determine the burden and determinants of anemia.

The main limitation of this study is that the HIV status of mothers was assessed using antibody tests. However, the number of mothers with a window period in the community is so small that this limitation will not create much problem. The burden of iron-deficiency anemia was highest in infants.

Infantile anemia was associated with maternal HIV status, stunting, residence, history of maternal malaria during pregnancy, history of cough or fever 7 days preceding the survey, income, use of cow milk before 6 months, family size, age of the mother, educational status of the mother, and maternal hemoglobin level. Decision makers should give special emphasis on intervention against infantile anemia. Both maternal and infant factors should be considered in targeting anemia control and prevention in infants.

Multisectoral intervention should be considered in infantile anemia prevention and control programs. The author wants to acknowledge the Ministry of Health for financially sponsoring this research. He would also like to acknowledge the Amhara Regional State Health Bureau for giving the necessary information.

Also he wants to acknowledge all organizations and individuals that have contributed to make this practical research. Author contribution: BEF conceived and designed the experiment; BEF performed the experiment, analyzed, and interpreted the data. BEF wrote the manuscript. The author has no conflict of interest to disclose. National Center for Biotechnology Information , U. Published online Aug 7. Author information Article notes Copyright and License information Disclaimer.

Published by Wolters Kluwer Health, Inc. All rights reserved. Abstract Children, especially infants, are highly vulnerable to iron-deficiency anemia because of their rapid growth of the brain and the rest of the body. Keywords: anemia, determinants, HIV infection, infants, prevalence.

Introduction Red blood cells are one of the formed elements of blood and they perform transportation of nutrients and waste products. Open in a separate window. Population profile of infants born from HIV-positive mothers A total of infants were included for a response rate of Conclusion The burden of iron-deficiency anemia was highest in infants.

Recommendation Decision makers should give special emphasis on intervention against infantile anemia. Acknowledgments The author wants to acknowledge the Ministry of Health for financially sponsoring this research.

Contributed by Author contribution: BEF conceived and designed the experiment; BEF performed the experiment, analyzed, and interpreted the data.

References 1. Blann A. Functions and diseases of red and white blood cells. Nurs Times ; — Lutter CK. Iron deficiency in young children in low-income countries and new approaches for its prevention.

J Nutr ; — Control of Iron Deficiency. Copenhagen: WHO; Geneva: World Health Organization; Trowbridge F, Martorell R. Forging effective strategies to combat iron deficiency.

Donna Mildvan. Causes of Weak Nails. Figure 1 flow chart shows how the study participants were selected. What Causes Earwax. An HbA1c test measures the amount of glycated hemoglobin, which is hemoglobin that has glucose attached to it, in your blood. Simplified diagnostic approach to anemia in HIV-infected individuals [ 39 ].

Heamoglobin levels in hiv positive children

Heamoglobin levels in hiv positive children

Heamoglobin levels in hiv positive children

Heamoglobin levels in hiv positive children

Heamoglobin levels in hiv positive children. Introduction

Although the prevalence of severe anemia has decreased since the introduction of HAART, mild-to-moderate anemia continues to be common [ 39—42 ].

After 12 months, further improvements were recorded, with Studies have shown that, as hemoglobin levels decrease, the risk of disease progression increases [ 17 , 20 , 29 , 43 , 44 ]. The relative hazard of clinical progression was 2. The relative hazard of clinical progression was 7. In a study of 19, patients by Sullivan et al. A study of patients reported by Moore et al. Mocroft et al. Determination of whether a cause-and-effect relationship exists between correction of anemia and improved survival is an important area for future research.

Address correctable causes of anemia. The clinical evaluation of an HIV-infected person with anemia should attempt to identify treatable underlying causes, including hypogonadism table 3. A simplified approach to the assessment of anemia in patients with HIV infection is illustrated in figure 4. To the extent possible, treatable causes should be corrected. In patients whose anemia is severe, transfusion should be considered for alleviation of acute symptoms.

Simplified diagnostic approach to anemia in HIV-infected individuals [ 39 ]. HAART use may result in improvement of existing anemia. Use of epoetin alfa. In multiple controlled and uncontrolled studies, epoetin alfa has been proven safe and effective for the treatment of anemia in HIV infection. Consensus recommendations. Monitor hemoglobin levels routinely e. Ask patients whether they are fatigued and determine whether there is impairment of physical functioning.

Anticipated benefits of epoetin alfa treatment weighed against its cost must be considered by the clinician in the absence of data from rigorous cost-benefit analyses. Guidelines for dose titration of epoetin alfa for anemic, HIV-positive patients [ 46 ]. Hb, hemoglobin. Ribavirin in combination with IFN or pegylated interferon IFN is the standard of care for treatment of HCV infection, but it has been shown to cause anemia, frequently leading to dosage reduction and potentially suboptimal outcomes [ 14 , 47 ].

When treating patients with ribavirin-related anemia, hemoglobin levels should be monitored, and epoetin alfa should be added to the treatment regimen in the presence of anemia. In patients with HCV infection alone, epoetin alfa 40, U once per week has been shown to effectively treat anemia associated with ribavirin therapy, to allow maintenance of ribavirin dose, and to reduce discontinuation rates, and it may also improve quality of life [ 48—52 ].

Future research should focus on furthering understanding of the causes of anemia, its long-term consequences and prognostic importance, the impact of various HAART regimens on the prevalence of anemia, and optimal dosing strategies for the use of epoetin alfa in special populations.

Emerging data suggest that epoetin alfa has effects beyond erythropoiesis. There is evidence, for example, that epoetin alfa has antiapoptotic effects in multiple cell lines, which may have a positive impact on the immunologic response in patients with HIV infection [ 53 , 54 ].

A recent pilot study of patients demonstrated benefit in acute ischemic stroke, with an improvement in clinical outcome at 1 month [ 56 ]. It is thus conceivable that epoetin alfa may one day prove useful in the treatment of neurologic conditions, including stroke and cognitive dysfunction. Factors involved in cost-benefit studies should include identification of the predictors of a response to therapy, determination of optimal doses and schedule of treatment, calculation of the associated costs of treatment, and consideration of any effects of therapy on the natural history of HIV infection.

Despite use of lower dosages of zidovudine and the introduction of HAART, mild-to-moderate anemia still occurs in a substantial portion of HIV-infected persons and is associated with increased mortality, increased disease progression, and reduced quality of life.

Hemoglobin levels and functional status should be monitored in a systematic manner on an ongoing basis. When anemia is present, treatable causes should be corrected. Administration of epoetin alfa once per week is appropriate for the treatment of chronic anemia.

Future research on epoetin alfa in HIV-infected patients, beyond its effects on erythropoiesis, is warranted. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation.

Volume Article Contents. The Anemia in Hiv Working Group. Reprint or correspondence: Dr. Oxford Academic. Google Scholar. Alexandra M. Douglas Dieterich. Donna Mildvan. Ronald Mitsuyasu. Michael Saag.

Cite Citation. Permissions Icon Permissions. Abstract Anemia in human immunodeficiency virus HIV —infected patients can have serious implications, which vary from functional and quality-of-life decrements to an association with disease progression and decreased survival. Open in new tab Download slide.

Drugs that commonly cause myelosuppression in HIV-infected patients. Risk factors currently associated with anemia in HIV infection. Linear Analog Scale Assessment for determining quality of life.

Circulating autoantibodies to erythropoietin are associated with human immunodeficiency virus type 1-related anemia. Search ADS. Anemia, neutropenia, and thrombocytopenia: pathogenesis and evolving treatment options in HIV-infected patients. Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Red cell autoantibodies in patients with acquired immune deficiency syndrome.

Toxoplasmosis-associated hemophagocytic syndrome in a patient with AIDS: diagnosis by the polymerase chain reaction. Reactive haemophagocytic syndrome in human immunodeficiency virus infection. Thrombotic thrombocytopenic purpura in patients with human immunodeficiency virus infection: a report of three cases and review of the literature. Vitamin B 12 malabsorption in patients with acquired immunodeficiency syndrome. The Anemia Prevalence Study Group. Google Preview.

Prevalence and cumulative incidence of and risk factors for anemia in a multicenter cohort study of human immunodeficiency virus-infected and uninfected women. Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. Recombinant human erythropoietin for patients with AIDS treated with zidovudine.

Recombinant human erythropoietin in the treatment of anemia associated with human immunodeficiency virus HIV infection and zidovudine therapy. Iron-deficiency anemia and the cycle of poverty among human immunodeficiency virus-infected women in the inner city. Malnutrition is an important factor which might predict disease progression of HIV-infected individuals.

Wasting and weight loss are common features of HIV infection, especially in resource-limited settings. Although there are studies on anemia and the nutritional status of HIV-infected children in Ethiopia, 7 there have been no studies done in the eastern part of the country. The facility began providing ART service in ; since then, children have attended to receive the treatment. All the children registered for ART in the hospital from the very beginning of the service provision were considered.

Those who started ART clinically 20 children , those who dropped out early 15 children , those who transferred into the ART program 6 children , those who transferred out of the program early 12 children , and those whose records were incomplete 22 children were excluded from the study; resulting in children included in the study.

Figure 1 flow chart shows how the study participants were selected. Data were collected by nurses who were working in the ART unit of the hospital. Data were entered into SPSS version 15, cleaned, and analyzed. Children aged less than 7 years were taken as preschool age, while those above 7 years were identified as school children.

The prevalence of anemia was determined as the proportion of anemic children. Univariate and multivariate logistic regressions were employed to identify the possible risk factors of anemia. Information that was obtained during this study was kept confidential. A total of children participated in this study, of whom Their mean age was 7. Few participants presented with smear-positive TB A total of children had CD4 levels at baseline with mean of The overall level of adherence to ART was The prevalence of anemia among children was Of anemic children, The prevalence of anemia was higher in those children who were underweight, and stunting but were not in no wasting group before the initiation of ART.

The mean hemoglobin levels before and after initiation of ART were The prevalence of anemia declined from The prevalence of underweight children declined to 8. Exactly 6. In addition, approximately In univariate analyses, the odds of being anemic were 4. Those variables with P -values less than 0. In this analysis, the odds of being anemic were 4. In addition, the odds of being anemic were 2. Before initiation of ART in children, anemia in this study This finding was similar to findings in other similar studies.

There was a high prevalence of underweight, stunting, and wasting in children before the initiation of ART in this study. This is in agreement with some other reports. However, it was correlated in one other study. The prevalence of anemia, underweight children, stunting, and wasting declined 1 year after the initiation of ART. The positive effects of using ART on the nutritional and anemic status of children has been published in other studies. This result is similar to a study from Jimma, Ethiopia.

This result is different when compared to 0. The difference might also be due to differences in study design and sampling techniques. Those children with missing data were not included in this study, and this exclusion can be a potential limitation in a retrospective study. Thus, the true prevalence of anemia and malnutrition in our study area might not be reflected.

They declined after initiation of ART, which highlights the importance of the treatment. Unfortunately, the problems in HIV-infected children still need attention.

We thank Muna Abdela for helping with data entry. Author contributions. ZT and FM participated in proposal writing, data collection, analysis, interpretation, and critical revision of the manuscript. HM participated in data analysis, interpretation, and critical revision of the manuscript.

All authors read and approved the final manuscript. National Center for Biotechnology Information , U. Published online Jun 5. Author information Copyright and License information Disclaimer. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. This article has been cited by other articles in PMC.

Abstract Purpose Anemia and growth retardation are common manifestations of HIV-positive children, which threaten their lives.

Paul A. Volberding, Alexandra M. Anemia in human immunodeficiency virus HIV —infected patients can have serious implications, which vary from functional and quality-of-life decrements to an association with disease progression and decreased survival.

In , 16 members of the Anemia in HIV Working Group, an expert panel of physicians involved in the care of HIV-infected patients that met first in , reconvened to assess new data and to translate these data into evidence-based treatment guidelines. The group reached consensus on the prevalence of anemia in the highly active antiretroviral therapy era; the risk factors that are independently associated with the development of anemia; the impact of anemia on quality of life, physical functioning, and survival; the impact of the treatment of hepatitis C virus coinfection on anemia in HIV-infected patients; evidence-based guidelines for treatment of anemia in HIV-infected patients, including the therapeutic role of epoetin alfa; and directions for future research.

In , the Anemia in HIV Working Group issued a consensus statement addressing the impact of anemia on HIV-infected individuals, as well as treatment strategies and future research directions. The Anemia in HIV Working Group reconvened in to evaluate recently available data and to determine the implications of those data for patient management. The consensus statement that follows is based on evidence in the published literature, clinical experience, and the expert opinion of the panel. The chairpersons selected panelists from among the participants in the Anemia in HIV Working Group meeting and other experts who are involved in HIV study and who specialize in the hematological complications of the disease.

An obvious cause of anemia in patients with HIV infection is blood loss. Blood loss may be associated with such conditions as neoplastic disease e. Decreased RBC production. Decreased RBC production may be a consequence of infiltration of the bone marrow by neoplasm [ 1 ] or infection [ 2 ], use of myelosuppressive medications table 1 [ 3 ], HIV infection itself [ 3 ], a decreased production of endogenous erythropoietin, a blunted response to erythropoietin [ 4 ], or hypogonadism.

Increased RBC destruction i. Increased or premature RBC destruction in the spleen or the circulator system may occur in patients with HIV infection.

Hemolytic anemia may result from RBC autoantibodies, hemophagocytic syndrome, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, or glucosephosphate dehydrogenase deficiency [ 3 , 6—11 ].

Hemolysis may also develop as a consequence of the use of various medications [ 12 ]. Ineffective RBC production. In patients with HIV disease, folic acid deficiency is generally caused by either dietary deficiency or jejunal pathology [ 3 ]. Vitamin B 12 deficiency may result from malabsorption in the ileum or from gastric pathology caused by an array of infections or other conditions that affect the gastric mucosa in HIV-infected patients [ 13 ].

Presumably, the increased prevalence of anemia in female HIV-infected persons, compared with male individuals, reflects the overall higher prevalence of anemia in female persons, which may be largely attributed to menstrual blood loss and to the drains on iron stores that occur with pregnancy and delivery. African American individuals with HIV infection may be at particular risk for the development of anemia, in part as a result of the presence of inherited hematologic disorders, such as sickle cell disease and thalessemia.

Dietary factors may also be involved [ 23 ]. Prevalence of anemia, by race, in a cohort of HIV-infected patients [ 16 ]. Zidovudine treatment. Zidovudine treatment is associated with bone marrow suppression and an increased risk of developing anemia [ 21 , 24—28 ].

Worsening HIV disease parameters. Although no causal relationship has been documented, retrospective analyses have found an association between anemia at baseline, decreased survival, and increased disease progression in patients with HIV infection [ 17 , 20 , 29 , 30 ]. Kaplan-Meier progression to death for patients in the EuroSIDA study, according to baseline hemoglobin level, in multivariate analysis [ 20 ].

Survival rates improved markedly among subjects recovering from anemia. Impact of fatigue. Fatigue is a common symptom of HIV infection and is associated with impaired physical functioning, psychological distress, and decrements in quality of life [ 31 , 32 ].

Although the etiology of HIV-related fatigue may be multifactorial [ 33 ], anemia is considered an important contributing factor or underlying cause [ 31 ]. Employment problems and sleep disturbances were shown to contribute to morbidity and disability in the HIV-infected group. In a later study of patients by Breitbart et al.

A substudy of patients from the ongoing multinational INITIO trial of antiretroviral therapy—naive patients revealed an independent relationship between low baseline levels of hemoglobin and overall quality of life [ 35 ].

Impact of correction of anemia. Correction of anemia in patients with HIV infection has been associated with meaningful improvements in quality of life and physical functioning.

Abrams et al. In a recent study, Grossman et al. Although the prevalence of severe anemia has decreased since the introduction of HAART, mild-to-moderate anemia continues to be common [ 39—42 ]. After 12 months, further improvements were recorded, with Studies have shown that, as hemoglobin levels decrease, the risk of disease progression increases [ 17 , 20 , 29 , 43 , 44 ]. The relative hazard of clinical progression was 2. The relative hazard of clinical progression was 7.

In a study of 19, patients by Sullivan et al. A study of patients reported by Moore et al. Mocroft et al. Determination of whether a cause-and-effect relationship exists between correction of anemia and improved survival is an important area for future research. Address correctable causes of anemia. The clinical evaluation of an HIV-infected person with anemia should attempt to identify treatable underlying causes, including hypogonadism table 3.

A simplified approach to the assessment of anemia in patients with HIV infection is illustrated in figure 4. To the extent possible, treatable causes should be corrected. In patients whose anemia is severe, transfusion should be considered for alleviation of acute symptoms. Simplified diagnostic approach to anemia in HIV-infected individuals [ 39 ]. HAART use may result in improvement of existing anemia.

Use of epoetin alfa. In multiple controlled and uncontrolled studies, epoetin alfa has been proven safe and effective for the treatment of anemia in HIV infection. Consensus recommendations. Monitor hemoglobin levels routinely e. Ask patients whether they are fatigued and determine whether there is impairment of physical functioning. Anticipated benefits of epoetin alfa treatment weighed against its cost must be considered by the clinician in the absence of data from rigorous cost-benefit analyses.

Guidelines for dose titration of epoetin alfa for anemic, HIV-positive patients [ 46 ]. Hb, hemoglobin. Ribavirin in combination with IFN or pegylated interferon IFN is the standard of care for treatment of HCV infection, but it has been shown to cause anemia, frequently leading to dosage reduction and potentially suboptimal outcomes [ 14 , 47 ]. When treating patients with ribavirin-related anemia, hemoglobin levels should be monitored, and epoetin alfa should be added to the treatment regimen in the presence of anemia.

In patients with HCV infection alone, epoetin alfa 40, U once per week has been shown to effectively treat anemia associated with ribavirin therapy, to allow maintenance of ribavirin dose, and to reduce discontinuation rates, and it may also improve quality of life [ 48—52 ]. Future research should focus on furthering understanding of the causes of anemia, its long-term consequences and prognostic importance, the impact of various HAART regimens on the prevalence of anemia, and optimal dosing strategies for the use of epoetin alfa in special populations.

Emerging data suggest that epoetin alfa has effects beyond erythropoiesis. There is evidence, for example, that epoetin alfa has antiapoptotic effects in multiple cell lines, which may have a positive impact on the immunologic response in patients with HIV infection [ 53 , 54 ].

A recent pilot study of patients demonstrated benefit in acute ischemic stroke, with an improvement in clinical outcome at 1 month [ 56 ]. It is thus conceivable that epoetin alfa may one day prove useful in the treatment of neurologic conditions, including stroke and cognitive dysfunction. Factors involved in cost-benefit studies should include identification of the predictors of a response to therapy, determination of optimal doses and schedule of treatment, calculation of the associated costs of treatment, and consideration of any effects of therapy on the natural history of HIV infection.

Despite use of lower dosages of zidovudine and the introduction of HAART, mild-to-moderate anemia still occurs in a substantial portion of HIV-infected persons and is associated with increased mortality, increased disease progression, and reduced quality of life. Hemoglobin levels and functional status should be monitored in a systematic manner on an ongoing basis.

When anemia is present, treatable causes should be corrected. Administration of epoetin alfa once per week is appropriate for the treatment of chronic anemia. Future research on epoetin alfa in HIV-infected patients, beyond its effects on erythropoiesis, is warranted.

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. The Anemia in Hiv Working Group. Reprint or correspondence: Dr. Oxford Academic. Google Scholar. Alexandra M. Douglas Dieterich. Donna Mildvan. Ronald Mitsuyasu.

Michael Saag. Cite Citation. Permissions Icon Permissions. Abstract Anemia in human immunodeficiency virus HIV —infected patients can have serious implications, which vary from functional and quality-of-life decrements to an association with disease progression and decreased survival.

Heamoglobin levels in hiv positive children