Consensus statement: Anemia in HIV infection - Current trends, treatment options, and practice strategies

Background: Despite important advances in antiretroviral therapy, anemia re mains a problem in many HIV-infected patients. Although the incidence of an emia in these patients has decreased, its prevalence appears to have stabil ized or decreased only slightly. Anemia has a deleterious effect on both fu nctional capacity and quality of life, and has been associated with shorten ed survival. Objective: The Anemia in HIV Working Group, an expert panel of physicians a nd researchers involved in the care of HIV-infected patients, met to determ ine the impact of anemia in this patient population; to develop practice st rategies for the clinician treating HIV-infected patients with anemia; and to identify future research directions. Methods: The proposed practice strategies are based on results of the avail able clinical trials (as identified through a MEDLINE(R) search), a review of the literature, and the clinical experience and expert opinion of the pa nel. The present report is based on meetings held in February and June of 1 998; as further experience with various treatment options accumulates and t he impact of highly active antiretroviral therapy becomes clearer, the pane l will reconvene to develop evidence-based guidelines. Results: The working group considers HIV-associated anemia to be an importa nt contributor to the morbidity and mortality of this infection. Recent rep orts indicate that recovery from anemia is associated with improved quality of life and survival. Conclusions: As HIV-infected persons live longer, maintaining quality of li fe becomes an increasingly important goal of treatment. When planning treat ment strategies, clinicians should consider the quality-of-life decrement c aused by anemia. Transfusions should be used when rapid recovery is require d, and underlying conditions causing anemia should be treated, if possible. Recombinant human erythropoietin (rHuEPO) therapy is appropriate in certai n HIV-infected persons and should be considered to maintain hemoglobin conc entrations. The target hemoglobin level is 12 g/dL for men and 11 g/dL for women. Weekly rHuEPO dosing is suggested, initiated at 40,000 U, as has bee n established in patients with cancer.