Common Sense About AIDS

Tracking red blood count improves life with HIV/AIDS

Anemia can be major problem

A recent survey has shown that a majority of HIV-positive Americans say their doctors have not discussed anemia with them, despite the fact that the condition can be a common problem for people with the disease. More than four out of five people diagnosed with HIV said they have experienced tiredness, and two-thirds said they have experienced weakness, according to the survey conducted by Harris Interactive of Rochester, NY, on behalf of Ortho Biotech Products of Raritan, NJ. The survey included 669 interviews with HIV-positive people and was conducted by telephone and on-line, says Cathy Shores, vice president of public relations and media research for Harris Interactive in Scarsdale, NY.

Another finding of the study was that while most doctors (86%) ask their HIV-positive patients whether they experience symptoms associated with anemia, fewer than half (46%) of HIV-positive people say their doctor has discussed anemia with them. Here are some of the survey’s chief findings about HIV/AIDS and anemia:

— Two-thirds of people living with HIV are not sure at what level their red blood cell count would indicate that their health is at risk.

— About 82% of those diagnosed with anemia have had to cut back on everyday activities, such as working, household chores, sexual activities, exercising, and socializing.

— About 58% of people with HIV agree that they need their doctor to better inform them about their blood test results so they can understand the problems they may face.

— While 96% of those surveyed said their doctor regularly monitors their T-cell count and 94% said their viral load is regularly monitored, only 67% said they believe their doctor regularly monitors their red blood cell count.

— Only 18% of HIV-positive individuals surveyed knew at what level their red blood cell count puts their health at risk.

— About 38% of those surveyed said they believe medication can treat anemia.

— About 76% of those surveyed who have anemia said anemia has impacted their life either extremely, severely, or moderately.

— About 28% of those surveyed said they are not sure what HIV-related anemia is.

— Of those surveyed with anemia, 96% said they have felt tired since being diagnosed with HIV, compared with 83% of HIV-infected people without anemia.

— Nearly 60% of those surveyed said anemia interfered with their everyday activities at least somewhat.

— Another 57% of those surveyed said anemia has impacted their social relationships either moderately or severely through these problems:

  • 86% said they had experienced weakness;
  • 76% experienced a loss of sex drive;
  • 71% reported headaches;
  • 64% experienced a loss of appetite.

Harris Interactive has put together some detailed information about anemia specifically for people living with HIV/AIDS. Here is some of that information:

About HIV-related Anemia

Simple activities that many people take for granted — such as climbing stairs, walking the dog, meeting a friend for coffee — can cause people living with HIV/AIDS to feel exhausted and weak. While sometimes this is the result of the disease itself, it can be the result of anemia — a condition that, if left untreated, may become severe enough to interfere with a person’s daily activities and overall well-being.

The Condition

Anemia is a condition in which the body does not have as many red blood cells as it should. Red blood cells are produced in bone marrow and contain hemoglobin, the iron-containing protein responsible for carrying oxygen throughout the body.

The natural hormone called erythropoietin (EPO), which is made in the kidneys, stimulates bone marrow production of red blood cells. When an insufficient number of red blood cells is produced, hemoglobin levels drop, and the blood is no longer able to carry enough oxygen to nourish the body’s tissues. HIV-related anemia is characterized by symptoms such as muscle weakness, shortness of breath, headache, dizziness, rapid heartbeat, and fatigue and can be a potentially debilitating condition.

Some causes of anemia, such as deficiencies in diet and blood loss, are temporary and treatable. Other chronic causes are often treatment-related and are more difficult to manage. For example, people with HIV are at special risk for anemia because many of the medications they use to treat their condition, such as AZT-containing regimens, can suppress bone marrow and subsequently reduce red blood cell count.

The amount of red blood cells in your body may be determined by measuring hematocrit or hemoglobin. Hematocrit is the volume percentage of red blood cells in whole blood. Hemoglobin is the amount of the oxygen-carrying molecule found in the blood and is measured in grams per deciliter of blood (g/dL). Hemoglobin and hematocrit are assessed using a routine blood test called a complete blood count.

Incidence and Prevalence

Anemia is a common complication among people living with HIV/AIDS. Those with advanced-stage AIDS are at particular risk. Recent reports estimate that anemia occurs in up to 95% of patients over the course of their infection, making it more common than other blood cell conditions, such as platelet depletion (thrombocytopenia) or white blood cell depletion (leukopenia).

Several studies have examined the incidence of anemia in HIV-infected persons and compared the risk of death of patients who developed anemia to those who did not develop the condition. One study, conducted by the Centers for Disease Control and Prevention of Atlanta and based on medical records of more than 32,000 patients, found that the risk of death was 148% greater among those patients (CD4 count > 200 cells/mL) who developed anemia than among those patients who did not.

Treatment

Treating anemia in people with HIV/AIDS may improve the patient’s ability to engage in everyday activities and cope with the disease. While physicians have traditionally relied on blood transfusions to raise red blood cell levels and help restore energy, many now try to avoid them because of the potential risk of infection, particularly in those populations with suppressed immune systems.

There are medications that can supplement the body’s natural supply of EPO to help increase hematocrit and hemoglobin levels. Patients should consult their health care professional for more information about treatments for anemia.

Anemia is a serious problem for people living with HIV/ AIDS. Recognizing the symptoms of anemia, monitoring patient hemoglobin levels, and aggressively treating the condition can help patients resume their normal daily routines.

Here’s an action checklist for people living with HIV:

  • Learn to recognize the signs and symptoms of anemia.
  • Keep a diary of your signs and symptoms. This will help you have a more informed discussion with your doctor.
  • Talk to your doctor about your symptoms.
  • Ask your doctor about being tested.
  • Ask for the results of your blood test.
  • Ask your doctor about prescription medications to treat anemia.
  • Talk to your doctor about dietary changes, exercise, and rest.