Treatment for anemia in people with AIDS: Cochrane systematic review

Abstract

Assessed as up to date: 2010/11/14

Background

Anemia is common in persons with HIV infection and is associated with poor prognosis. There is a need to assess the effects of anemia treatments, and to determine whether these interventions are beneficial.

Objectives

To determine the efficacy and safety of treatments for anemia in people with HIV infection and AIDS.

Search methods

The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 10, 2010), MEDLINE (1980-November 25, 2010), EMBASE (1980-November 25, 2010), LlLACS (1982 to November 25, 2010), Africa Index Medicus (up to November 9, 2010), ISI Web of Knowledge (2005 to October 9, 2010), Scirus (October 9, 2010) reference lists of relevant articles. We asked the Cochrane HIV/AIDS and Pregnancy and Childbirth Groups to check their Specialised Registers. We also checked the reference lists of all trials identified by the above methods.

Selection criteria

Randomized trials assessing the effects of treatments for anemia in people diagnosed with HIV infection. There were no age restrictions.

Data collection and analysis

Two authors independently assessed relevant studies for inclusion. Data extraction and quality assessment of relevant studies was performed by two authors and checked by the other two authors.

Main results

Six trials with a high risk of bias, including 537 patients, met the inclusion criteria. These trials only covered recombinant Human erythropoietin alfa (rHuEPO). Two of them including adult and paediatric participants (84 participants and 4 events) comparing rHuEPO to placebo did not reduce the risk of mortality with a follow up to 12 weeks (pooled RR 0.56, 95% confidence interval (CI) 0.08 to 4.05, I2 = 0%). Any trials that compared rHuEPO to placebo did not show any benefit on hematological values response, number of patients transfused, or number of packed red cell transfused. Two trial compared the effects of two rHuEPO dosing regimens on hemoglobin value and quality of life, but the effects are unclear. Three RCT reported high risk of attrition bias; therefore, were not included in a meta-analysis.

Authors' conclusions

This updated Cochrane review provides evidence that rHuEPO compared with placebo does not reduce mortality, does not reduce transfusion requirements, did not increase hemoglobin levels, and did not improve quality of life in HIV-infected patients with anemia. The results are based on six RCTs with high risk of bias. Therefore prescription of this intervention for treating anemia in patients with AIDS is not justified, unless new evidence from a large high quality trial alters this conclusion.

Author(s)

Martí-Carvajal Arturo J, Solà Ivan, Peña-Martí Guiomar E, Comunián-Carrasco Gabriella

Summary

Treatment for anemia in people with AIDS

There is a lack of reliable evidence on interventions for treating anemia in persons with HIV infection or AIDS. Persons with HIV infection or AIDS are more likely than the general population to develop anemia, and anemia is the most common blood disorder in the HIV/AIDS infected population. Compared to those who do not develop anemia, HIV-infected individuals who develop anemia are more likely to die early. It is important, therefore, to have good evidence regarding interventions that might be used to treat anemia. This update Cochrane review six randomized trials (537 participants), all of which investigated recombinant human erythropoietin. It did not reduce mortality and transfusion requirements. Furthermore, recombinant human erythropoietin did not increase hemoglobin levels and improve quality of life in HIV-infected patients with anemia. All trials were judged to be of poor methodological quality.

Potential randomised trial should include outcomes such as mortality and quality of life, and pregnant women, children and all ethnic people. Furthermore, trial should be sponsored by World Health Organization with an international board committee.

Reviewer's Conclusions

Implications for practice

This Cochrane review provides evidence that rHuEPO used for treating anemia in people with AIDS does not reduce mortality. The results are based on six studies (537 patients) assessing rHuEPO compared with placebo. The included trials (with a high risk of bias) did not show a benefit in preventing mortality in paediatric and adult patients. Therefore prescription of this intervention is not justified, unless new evidence from a large high quality trial alters this conclusion, for treating anemic patients with AIDS.

Implications for research

This systematic review has shown the pressing need for well-designed, high-quality randomized trials to assess the benefits and harms of interventions to decrease mortality associated with anemia in persons with HIV infection. The RCT should include outcomes such as mortality and quality of life. Due to new knowledge on pathogenesis of anemia of chronic disease, biological drugs such anti IL-6 and hepcidin blocking should be tested or developed. Furthermore, these potential RTCs including pregnant women, children and all ethnic people should test the role of the iron. Finally, the RCT should be sponsored by World Health Organization with an international board committee.

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