The Impact of Anemia on Energy and Physical Functioning in Individuals With AIDS

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Abstract
Anemia is the most common morbidity of human immunodeficiency virus (HIV) infection and is associated with increased progression to AIDS and higher mortality.1 The consequences of anemia include fatigue, a decreased sense of well-being, and an increased need for expensive human recombinant erythropoietin therapy, transfusions, and hospitalizations.1 Although the impact of anemia on the quality of life of patients with cancer has been well established, less is known about the effect of anemia on fatigue and quality of life in HIV-infected patients.2-4 The Anemia in HIV Working Group has recommended that the impact of anemia on energy/fatigue and anemia-related quality-of-life indicators needs further characterization.5 The energy and physical functioning scales of the Medical Outcomes Study HIV Health Survey (MOS-HIV), the most widely used quality-of-life instrument in HIV studies, are reliable and have discriminant validity in HIV-infected patients.6 Large increases in hematocrit among anemic patients who received recombinant human erythropoietin therapy were associated with substantial improvement in energy scales and physical functioning in HIV-infected adults.4,7 It is unclear if hemoglobin is associated monotonically with energy and physical functioning across the full range of concentrations or whether there is a threshold above which there is no subjective benefit of increasing the hemoglobin concentration. A recent study8 suggests that the relationship between hemoglobin and physical functioning may extend well into the range of what are conventionally defined as “normal” hemoglobin concentrations.