At the National Conference on Women and HIV/AIDS, investigators from the Women's Interagency HIV Study (WIHS) presented data on the prevalence of anemia in this cohort of women. WIHS, a prospective, longitudinal cohort study of HIV positive and at-risk HIV negative women, has enrolled over 2,600 women since 1994. The six study sites are the Bronx/Manhattan, Brooklyn, Chicago, Los Angeles, Washington, DC, and San Francisco. The objective of WIHS is to evaluate and better understand the spectrum of HIV disease in women.

Anemia is the most common hematologic (related to blood) abnormality in people with HIV/AIDS, estimated to occur in about 20% of new cases and in 65% of people with advanced HIV disease. Anemia may occur as a medication side effect, as a result of HIV-related illnesses, or as a consequence of HIV itself. A unique issue for women is menstruation, which may contribute to the development of anemia. Prior studies of anemia in HIV have enrolled mostly or exclusively men. In this study, 2,625 (2,056 HIV positive and 569 HIV negative) women were evaluated at the first visit. Anemia was defined as a hemoglobin level less than 11 g/dL (grams per decilitre).

Not surprisingly, HIV positive women were found more likely than HIV negative controls to have anemia. On multivariate analysis significant risk factors included a self-reported history of clinical AIDS; CD4 cell counts less than 200 cells/mm3; high viral load (risk is increased by 1.8 at 49,000-99,999 copies/mL and increased 2.2-fold when greater than 100,000 copies/mL); current AZT use; and mean corpuscular volume (MCV) of red blood cells lower than 80, suggesting iron deficiency. Further analysis of the WIHS cohort will consider the impact of anemia in HIV positive women. In general the data showed roles for low MCV and hemoglobin in anemia, but did not control for conditions such as thallasemia (a type or types of anemia that are hereditary, occurring most commonly in people of Mediterranean, African, or Southeast Asian ancestry) or sickle-cell disease.

At the National Conference on Women and HIV/AIDS, Alexandra Levine, MD, and others described positive results in correcting hemoglobin levels and in self-reported quality of life among HIV positive women with anemia who took once weekly epoetin alfa (Procrit) at a dose of 40,000 units subcutaneously for 16 weeks (based on preliminary, eight-week data). Once weekly epoetin alfa effectively resolved anemia in women of all disease stages regardless of whether or not they were taking AZT. The drug also was well tolerated and safe at the dose tested.