Anemia is a medical problem that happens when you have a lower than normal amount of red blood cells (RBCs) in your body. It can also happen if your hemoglobin (HGB) level is below normal. HGB is a protein that uses iron to carry oxygen. It is found in RBCs and gives blood its red color. HGB carries oxygen from the lungs to the rest of the body. If you have anemia, your body doesn’t get enough blood that carries oxygen.

Anemia can be mild, moderate, or severe. It can also be temporary or a longer-lasting problem. With severe or long-lasting anemia, the lack of oxygen in the blood can damage the heart, brain, and other organs of the body. Very severe anemia may even cause death.

At first anemia can be so mild that it goes unnoticed. Symptoms usually increase as anemia gets worse. Symptoms include:

• Severe fatigue (tiredness)
• Difficulty breathing
• Rapid heart rate
• Pale skin
• Decreased pinkness of the lips, gums, lining of the eyelids, nail beds, and palms
• Feeling cold
• Confusion or loss of concentration
• Dizziness or fainting
• Sadness or depression

Anemia has always been a problem for HIV+ people. Although the rate of serious anemia has dropped since people started using HIV drug combinations, anemia continues to affect up to 30 percent of HIV+ people taking HIV drugs. Factors that are linked to a higher rate of anemia in HIV+ people include:

• Being a woman
• Being African American
• Having lower CD4 cell counts
• Having a higher viral load
• Taking Retrovir (zidovudine, AZT)

Anemia is a common condition for HIV+ women, but it is often overlooked. If left untreated, anemia is strongly associated with HIV disease progression and an increased risk of death.

There are many possible causes of anemia, including:

• A shortage of the B vitamins: B12 and folic acid (folate)
• A shortage of iron, which is most commonly due to blood loss from internal bleeding, frequent nosebleeds, or heavy or long menstrual periods
• HIV infection itself
• Many opportunistic infections related to HIV disease
• Kidney or bone marrow damage
• Some thyroid conditions
• Some drugs that are commonly used to treat HIV and related infections

The good news is that with diagnosis and treatment the affects of anemia can be greatly reduced. Anemia is usually diagnosed by measuring HGB and hematocrit (HCT). HCT is the percentage of RBCs in the blood. HGB and HCT are measured as part of a routine blood test called a complete blood count (CBC). A CBC should be done as part of your regular health exams.

• HGB levels for women should be about 12 grams per deciliter (g/dL) – a HGB level of less than 6.5 g/dL is very dangerous and could be life-threatening
• HCT levels for women should be 35 percent to 46 percent

The treatment for anemia depends on the cause:

• If bleeding is the cause of the problem, the source should be found and controlled.
• If iron levels are low, that should be corrected (iron is often low in women). You may be able to change your diet to include foods with a lot of iron. Iron is found in red meat, seafood, and fortified bread and cereals. Taking iron tablets can also raise levels. Talk to your health care provider before taking extra iron.
• If your folic acid levels are low you may be able to add foods that contain folic acid to your diet. Folic acid is found in dark greens, asparagus, lima beans, spinach, and beef liver. You could also take folic acid tablets.
• If your vitamin B12 levels are low, you may need B12 injections or formulations of B12 you put under your tongue, no matter how much you get in your diet. This is because some people cannot absorb this vitamin from food or oral supplements.
• If a drug you are taking is causing anemia, it may be necessary to stop taking that drug.
• When advanced HIV is the cause of anemia, HIV treatment may improve symptoms.
  

There are also medications that help your body make more RBCs. These medications include the injectable drug erythropoietin or EPO (brand names Epogen and Procrit). Some people with severe anemia may need a blood transfusion. However, transfusions are a last resort for HIV+ people because they may increase the risk of opportunistic infections and death.

Good communication with your health care provider will help determine the best treatment for you based on what is causing the anemia.

Anemia is a common condition in HIV+ people, especially women. It can cause feelings of fatigue, lower your quality of life, and increase the risk of making HIV disease worse.

If you’re feeling tired for unexplained reasons or experiencing any of the other symptoms listed above, talk to your health care provider. He or she can run tests to determine if anemia is the problem. If so, your health care provider will look for the cause and suggest treatment options. Treating anemia improves the health and survival of HIV+ people.