Prevalence, Risk Factors, Clinical Significance and Management of Anaemia among People Living with HIV/AIDS: A Review

Anaemia is a common haematological complication among those who have human immunodeficiency virus (HIV) and is linked to a reduced quality of life, faster disease progression and higher mortality rates. This review looks at the extent of the problem, the mechanisms involved, the risk factors, the significance and the management of anaemia in people with HIV/AIDS, using evidence from sub-Saharan African areas, including Nigeria. Anaemia in HIV patients is due to a number of factors and can be caused by chronic immune activation and inflammation, by altered iron regulation via the interleukin-6–hepcidin pathway, by bone-marrow dysfunction, by decreased erythropoiesis, by a shorter red-cell survival time, by nutritional deficiencies, by opportunistic infections, by blood loss, by renal disease and by medication-related toxicity. The occurrence of anaemia depends on age, sex, nutritional status, CD4 cell count, viral load, the stage of the disease and the use of antiretroviral therapy (ART). Even though antiretroviral therapy can help to reduce HIV-related anaemia by suppressing viral replication and decreasing inflammation, some of the drugs, especially zidovudine, may lead to bone-marrow suppression. Anaemia is still common among those who are on treatment, particularly in settings with limited resources, and more severe anaemia is connected with worse outcomes and a higher risk of death. Effective management therefore involves identifying and treating the underlying causes, monitoring haemoglobin and other haematological indices, dealing with nutritional deficiencies and co-infections, and reviewing any medicines that could have a myelosuppressive effect. The review stresses the importance of assessing anaemia as part of HIV care in areas where the burden of the disease is high.