Anemia and HIV in the Antiretroviral Era: Potential Significance of Testosterone

Abstract

Anemia, the most common hematological disorder in human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), is associated with decreased quality of life and survival. Hypogonadism is prevalent in advanced HIV disease, however, low testosterone levels have not been customarily implicated in HIV-associated anemia. This study was undertaken to determine whether there is a relationship between testosterone levels and androgen use with anemia in HIV, and to characterize other clinical correlates of HIV-associated anemia. This was a cross-sectional, observational study of 200 HIV-positive patients at a public hospital HIV clinic from July 2000 to August 2001. A written questionnaire detailed previous and current medication use, opportunistic infections, and malignancies. Hematological and virological parameters, testosterone, and erythropoietin levels were measured; CD4(+) T lymphocyte count and viral load nadir and peak levels were obtained from the computerized medical record. Anemia was defined as hemoglobin <13.5 g/dl in men and <11.6 g/dl in women. Twenty-four percent of women and 28% of men were anemic. Anemia was associated with lymphopenia (adjusted OR 4.0, 95% CI 1.36-11.80), high erythropoietin levels (adjusted OR 7.73, 95% CI 2.92-20.48), and low testosterone levels (adjusted OR 3.27, 95% CI 1.01-10.60). Anemia was negatively associated with female sex (adjusted OR 0.30, 95% CI 0.11-0.85), current antiretroviral therapy (adjusted OR 0.43, 95% CI 0.20-0.95), current androgen use (adjusted OR 0.20, 95% CI 0.05-0.84), and macrocytosis (adjusted OR 0.23, 95% CI 0.09-0.61). Low testosterone levels may have a positive association and supplemental androgens a negative association with anemia in HIV disease.

Determination of hematological and immunological parameters among HIV positive patients taking highly active antiretroviral treatment and treatment naïve in the antiretroviral therapy clinic of Gondar University Hospital, Gondar, Northwest Ethiopia: a comparative cross-sectional study

“…This is supported by different studies in which normocytic-normochromic anemia is the commonest type of anemia in HIV patients [3-5,7,8]. Findings in New Delhi (66.5%) [7] in 2002 and in Nigerians (64%) between June, 2002 to July, 2003 [16] showed normocytic- normochromic anemia which supports this study findings.…”

“…The use of antiretroviral drugs could positively or negatively affect these parameters, depending on the choice of combination used. Although many drugs used for the treatment of HIV-related disorders are myelosuppressive, severe cytopenia is most often related to the use of zidovudine [5]. …”

Prevalence and correlates of anemia among HIV infected patients on highly active anti-retroviral therapy at Zewditu Memorial Hospital, Ethiopia

“…Similar to this study, some studies reported a high prevalence of anemia in males compared to females and attributed it to the fact that lower Hgb level is used to define anemia in women than men [ 26 , 27 ]. However, many previous studies reported a high prevalence of anemia in females compared to male HIV infected patients [ 8 , 28 ].…”

Burden of anemia and its association with HAART in HIV infected children in Ethiopia: a systematic review and meta-analysis

“…Although HAART is capable of reducing the incidence of anemia [14–17] through enhancing CD4 cell count and suppressing viral duplication, it can also cause anemia. For instance, cotrimoxazole, pentamidine and zidovudine often argued to be associated with reticuloendothelial iron block [18, 19]. Cytokines such as interleukin 1, tumor necrosis factor and the interferon play a role in impairing erythropoietin response by reducing concentration of marrow progenitors and erythroid colonies.…”