Recombinant Human Erythropoietin in the Treatment of Anemia Associated with Human Immunodeficiency Virus (HIV) Infection and Zidovudine Therapy

Henry, David H.; Beall, Gildon N.; Benson, Constance A.; Carey, John T.; Cone, Lawrence A.; Eron, Lawrence J.; Fiala, Milan; Fischl, Margaret A.; Gabin, Stephen J.; Gottlieb, Michael; Galpin, Jeffrey E.; Groopman, Jerome E.; Hooton, Thomas M.; Jemsek, Joseph G.; Levine, Randy L.; Miles, Steven A.; Rinehart, John J.; Rios, Adan; Rôbbins, William J.; Ruckdeschel, John C.; Smith, Jan D.; Spruance, Spotswood L.; Starrett, Barbara; Toney, John; Zalusky, Ralph; Abels, Robert I.; Bryant, Edward C.; Larholt, Kay; Sampson, Allan R.; Rudnick, Seth A.

doi:10.7326/0003-4819-117-9-739

Cited by 171 publications

(89 citation statements)

References 13 publications

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“…However, studies from developed countries suggest that use of HAART reduces the risk of anemia in patients with HIV infection and improves hemoglobin values in many patients who are already anemic at the time of HAART initiation. 6,[15][16][17] A better understanding of the causes of anemia is important because there are different approaches for treating anemia, such as transfusion, correction of nutritional deficiencies, recombinant human erythropoietin, 18 cessation of myelosuppressive therapies, 19 and prevention or treatment of the opportunistic infections.…”

Section: Introductionmentioning

confidence: 99%

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Masaisa¹,

Gahutu²,

Mukiibi³

et al. 2011

The American Journal of Tropical Medicine and Hygiene

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Abstract. To determine the prevalence and risk factors of anemia among human immunodeficiency virus (HIV)-infected women in Rwanda and the influence of highly active antiretroviral therapy (HAART) on anemia, we analyzed 200 HIV-positive women and 50 HIV-negative women in a cross-sectional study. Clinical examinations and iron and vitamin B 12 assays were performed, and complete blood counts, serum folic acid levels, and CD4 cell count determined. The prevalence of anemia was significantly higher among HIV-positive women (29%) than among HIV-negative women (8%) ( P < 0.001). Risk factors for anemia were lower body mass index (odds ratio [OR] = 3.4, 95% confidence interval [CI] = 2.4-4.1), zidovudine use (OR = 1.14, 95% CI = 1.01-1.29), lack of HAART (OR = 1.44, 95% CI = 1.21-1.67), oral candidiasis (OR = 1.4, 95% CI = 1.2-1.6), pulmonary tuberculosis (OR = 1.8, 95% CI = 1.7-2.2), cryptococcal meningitis (OR = 1.6, 95% CI = 1.21-1.8), Pneumocystis jiroveci pneumonia (OR = 1.41, 95% CI = 1.20-1.65) and CD4 lymphocyte count < 200 cells/µL (OR = 2.41, 95% CI = 2.01-3.07). The mean ± SD hemoglobin level of 10.9 ± 1.6 g/dL at HAART initiation significantly increased to 12.3 ± 1.5 g/dL in 8 months ( P < 0.001). Anemia increases with HIV stage, and HAART is associated with a significant improvement in hemoglobin levels.*Address correspondence to Jean Bosco Gahutu, Faculty of Medicine, National University of Rwanda, PO Box 30, Huye, Rwanda. E-mail: jgahutu@nur.ac.rw 457 ANEMIA IN HIV-INFECTED AND UNINFECTED WOMEN, RWANDA level < 11.5 mg/dL by using reference ranges based upon local control measurements in our laboratory, which is located at a moderate altitude of 1,768 meters. This limit was also shown by Beutler and Waalen. 20 Serum iron, vitamin B 12 , and folic acid levels were measured in the clinical laboratory of Ghent University Hospital. However, erythropoietin assays and the screening for malaria and chronic helminthes were not systematically conducted.The first-line HAART regimen at the time of the study consisted of stavudine or zidovudine, plus lamivudine, plus nevirapine or efavirenz; more patients used stavudine and nevirapine than zidovudine and efavirenz. For all the patients who initiated HAART at the time of entry into the study, they were all given a stavudine-based regimen. No patients were taking other antiretroviral medications such as tenofovir, abacavir, or protease inhibitors. Women receiving zidovudine for prevention of mother-to-child transmission of HIV were not included in the study population.Most patients were given cotrimoxazole prophylaxis with a dose of 1 tablet of 960 mg daily when CD4 cell counts were less than 350 cells/μL when possible. However, because many patients initially only sought care when they have reached advanced stages of immunosuppression, some patients were given prophylaxis at lower CD4 cell counts. No persons were offered ferrous sulfate and/or multivitamins for the treatment of anemia.Statistical analysis. All statistical analyses were performed with SPSS software ...

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Section: Introductionmentioning

confidence: 99%

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Masaisa¹,

Gahutu²,

Mukiibi³

et al. 2011

The American Journal of Tropical Medicine and Hygiene

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“…La anemia en los pacientes con SIDA se constituye en la alteración hematológica más frecuente, llegando a tener una prevalencia que varía entre el 3,2% en los pacientes asintomáticos hasta 21% en sujetos con un recuento de las CD4 inferior a 249 ( [3][4][5]14,[17][18][19][20]. La literatura anglosajona, en el caso de anemia, describe como la más frecuente a aquella ligada a enfermedad crónica en las personas con SIDA.…”

Section: Introductionunclassified

Anemia carencial y SIDA

et al. 2013

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RESUMENOBJETIVOS: Determinar el tipo mas frecuente de anemia en pacientes con SIDA y el grado de severidad de la anemia. MATERIAL Y MÉTODOS: Se estudió 100 pacientes, entre 18 y 60 años, infectados por virus de inmunodeficiencia humana (VIH) en estadio SIDA, de Lima Metropolitana y el Callao, desde enero a diciembre 2001. Se realizó hemograma, mielograma, dosaje sérico de hierro, saturación de transferrina, ferritina, folato y vitamina B12. Las muestras fueron procesadas en el Departamento de Patología Clínica del Hospital Nacional Dos de Mayo. RESULTADOS: De los 100 pacientes, 60% presentaron anemia severa, 30% moderada y 10% leve. La tipificación del cuadro anémico fue carencial en 70% y por enfermedad crónica en 30%. En el caso de anemia carencial, 25% fue ferropénica, 30% carencial mixta (ferropénica y megaloblástica) y 15% megaloblástica. De los casos con componente megaloblástico, 30 pacientes tuvieron deficiencia de folatos y 15 carencia de vitamina B12. CONCLUSIONES: La anemia prevalente fue la del tipo carencial. El grado de anemia predominante fue el severo. Palabras clave: Anemia; síndrome de inmunodeficiencia adquirida; trastornos nutricionales.NUTRITIONAL ANEMIA AND AIDS SUMMARY OBJECTIVES: To determine the type of anemia most frequent in patients with AIDS and the various degrees of anemia. MATERIAL AND METHODS: One hundred patients 18 to 60 year-old infected with human immune deficiency virus (HIV) with residence in Lima and Callao were studied from January to December 2001 for blood count bone marrow aspiration, serum iron, transferrin, ferritin, folate and vitamin B12 levels. Samples were evaluated at the "Dos de Mayo" Hospital Clinical Pathology Department. RESULTS: From the 100 patients, 60% had severe, 30% moderate and 10% light anemia; 70% nutritional and 30% due to chronic disease. In the nutritional anemia group, 25% was ferropenic anemia, 30% ferropenic and megaloblastic (double defect) and 15% megaloblastic. In the megaloblastic anemia group, 30 patients had folate deficiency and 15 vitamin B12 deficiency. CONCLUSIONS: Prevalent anemia was nutritional. Anemia's degree was frequently severe.

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“…There may be a role for EPO supplementation, particularly in patients with underlying malignancy [7] and HIV. [8] Intravenous iron may additionally benefit patients with functional iron deficiency. [9] MA is the other major nutritional anaemia caused by vitamin B 12 or folate deficiency.…”

Section: Substrate Deficiencymentioning

confidence: 99%

Anaemia: Approach to diagnosis

2016

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Anaemia is defined as a condition in which the number of red cells or their oxygen-carrying capacity is insufficient to meet physiological needs. It is the most common disorder globally and one of the conditions that general practitioners most frequently encounter. In the World Health Organization global database, anaemia is estimated to affect 1.6 billion people. As anaemia manifests in a wide range of conditions, it is important to embrace a structured diagnostic approach. The recommended approach set out in this article incorporates clinical and patho physiological considerations, red cell characteristics, and bone marrow activity. In this issue of CME, the first of two parts on anaemia, the causes of anaemia related specifically to decreased red cell production are discussed.

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Recombinant Human Erythropoietin in the Treatment of Anemia Associated with Human Immunodeficiency Virus (HIV) Infection and Zidovudine Therapy

Cited by 171 publications

References 13 publications

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Anemia in Human Immunodeficiency Virus–Infected and Uninfected Women in Rwanda

Anemia carencial y SIDA

Anaemia: Approach to diagnosis

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