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Pathogenesis of Anemia During Human Immunodeficiency Virus Infection
  1. Richard D. Semba,
  2. Glenda E. Gray
  1. From the Department of Ophthalmology (R.D.S.), Johns Hopkins University School of Medicine, Baltimore, Md
  2. Perinatal HIV Research Unit (G.E.G.), Chris Hani Baragwanath Hospital, Soweto, South Africa.
  1. Address correspondence to: R.D. Semba, MD, 550 North Broadway, Suite 700, Baltimore, MD 21205. E-mail rdsemba{at}
  2. Financial support was provided by the National Institute of Child Health and Human Development (HD32247, HD30042), the National Institute of Allergy and Infectious Diseases (AI41956), and the Fogarty International Center, the National Institutes of Health, and the United States Agency for International Development (Cooperative Agreement HRN A-0097-00015-00).

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Anemia is common during human immunodeficiency virus (HIV) infection1and is associated with increased progression to AIDS2and higher mortality.3It is estimated that up to 90% of adults and children develop anemia during HIV infection, especially in late disease.4,5Fatigue is a common manifestation of anemia during HIV infection.6Several etiologic factors have been implicated in the anemia associated with HIV infection, including deficiencies of iron, folate, vitamin B12, and vitamin A,7the anemia of chronic disease,8impaired erythropoietin production,9endogenous release of inhibitory cytokines,10 Mycobacterium avium complex infection,11human parvovirus B19 infection,12HIV infection of hematopoietic progenitor cells,13HIV infection of other bone marrow stromal cells,14and antiretroviral therapy.15The cause of anemia during HIV infection is often multifactorial with several mechanisms occurring simultaneously in a single patient (Figure 1). This report reviews the epidemiology, pathogenesis, diagnosis, and treatment of anemia associated with HIV infection, with an emphasis on gaps in knowledge and current research issues. Some of the existing data on anemia and HIV infection was collected before the advent of highly active antiretroviral therapy (HAART) in the late 1990s. The incidence and prevalence of anemia may have changed now in populations receiving HAART, but many of the observations made before HAART are relevant to most HIV-infected individuals worldwide. More than 90% of individuals infected with HIV live in developing countries where antiretroviral therapy is largely unavailable.16

Figure 1.

Interactions of factors involved in the pathogenesis of anemia. Abbreviations: MAC, Mycobacterium avium * complex; CMV, cytomegalovirus; TFN, tumor necrosis factor; IFN, interferon.

The prevalence of anemia during HIV infection seems to vary widely by demographic characteristics of the population and stage of the disease. The prevalence of anemia is generally higher in …

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