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Hematologic manifestations of HIV infection: Anemia

Timothy J Friel, MD
David T Scadden, MD
Section Editor
Stanley L Schrier, MD
Deputy Editor
Jennifer S Tirnauer, MD


Shortly after the first description of the acquired immunodeficiency syndrome (AIDS), cytopenias of all major blood cell lines were increasingly recognized in patients with HIV infection. As an example, in one early series of patients with AIDS, anemia was noted in approximately 70 percent, lymphopenia in 70 percent, neutropenia in 50 percent, and thrombocytopenia in 40 percent [1].

The incidence of the various cytopenias correlates directly with the degree of immunosuppression. However, isolated abnormalities, particularly thrombocytopenia, may be encountered as the initial presentation of human immunodeficiency virus (HIV) infection. As a result, HIV infection should be considered in the assessment of patients presenting with any type of cytopenia.

The causes and treatment of anemia in patients with HIV infection will be reviewed here. Similar issues regarding neutropenia, thrombocytopenia, coagulation defects, and lymphopenia are discussed separately. (See "Hematologic manifestations of HIV infection: Neutropenia" and "Hematologic manifestations of HIV infection: Thrombocytopenia and coagulation abnormalities" and "Techniques and interpretation of measurement of the CD4 cell count in HIV-infected patients".)


Anemia is the most common hematologic abnormality associated with HIV infection, affecting 60 to 80 percent of patients in late stage disease. While anemia may manifest as a mere laboratory abnormality in some individuals, others may experience typical symptoms (eg, fatigue, dyspnea, reduced exercise tolerance, diminished functional capacity) directly related to a reduction in hemoglobin concentration. (See "Approach to the adult patient with anemia".)

In a review of more than 32,000 patients infected with HIV, the yearly incidence of developing anemia increased with disease progression, affecting 3 percent of all patients with asymptomatic HIV infection, 12 percent of asymptomatic patients with CD4 cell counts <200/microL, and 37 percent of patients with an AIDS-related illness [2].


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Literature review current through: Sep 2016. | This topic last updated: Oct 2, 2015.
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