Impaired Appropriateness of Erythropoietin in Anaemic HIV Infected Patients

Background and Objective: Erythropoietin response to anaemia has been reported to be suboptimal in HIV infected anaemic patients. Among Africans, particularly Nigeria little or no reports have been published describing incidence, prevalence and correlation between erythropoietin and anaemia in HIV, and its effect on the course and outcome of management of HIV infected patients. This study was carried out to determine the degree of erythropoietin response in anaemic HIV infected persons.

Methods: A total of 120 subjects were studied. These comprised of the study group made up of 40 HIV infected treatment naive patients who had anaemia with Haemoglobin level <10g/dL and 80 control subjects who were age and sex matched. The controls consisted of 20 HIV infected non-anaemic individuals, 40 non-HIV infected anaemic individuals, and 20 non-HIV infected non-anaemic individuals. Blood samples were collected for haemoglobin estimation, white cell count and platelet count by automated counter. The CD4+ cell count was done by semi-automated flow cytometer. The viral load was quantitated using PCR- based diagnostic tests and serum erythropoietin level was estimated using ELISA technique. All patients gave written informed consent with ethical approval by the hospital ethics and research committee.

Results: The study groups consisted of 40 males and 80 females. The mean age of male HIV anaemic subjects (45.15±5.63, N=13) was significantly higher than that of the female HIV anaemic subjects (34.16±7.21, N=25) p=0.005. The mean CD4+ cell count of HIV non-anaemic subjects (530.55 cells/µL ±423.35) was significantly higher than HIV anaemic subjects (188.18 cells/µL ±157.09) (p=0.0009). Using regression equation the expected serum erythropoietin values for a given haemoglobin level in HIV subjects was estimated. The appropriateness of erythropoietin level was then determined and a ratio of <0.8 was considered inappropriate. Seventy one percent of the HIV anaemic subjects had erythropoietin response ratio less than 0.8.

Conclusion: There was a blunted erythropoietin response for the degree of anaemia in HIV compared with HIV negative subjects.