Background:  Anemia is commonly observed among patients with HIV infection. In previous studies it has been observed in 12% to 39 % of individuals with HIV and it is an independent predictor of quality of life and death. The use of erythropoietin has been recommended in patients with blood erythropoietin levels ≤500IU/L and previous studies have used erythropoietin doses of 100 to 300 IU/kg given 3 times a week or 40,000 IU once weekly. In resource-limited countries, there is a higher risk for anemia for patients in Sub-Saharan Africa because of the added challenges of nutritional deficiencies, intestinal parasites and malaria but the cost of the high dose of erythropoietin is prohibitive. We hypothesized that low-dose erythropoietin is effective in the management of HIV associated grade 1-2 anemia

Methods:  A randomized open-label study included 108 out-patient HIV-infected individuals with grade 1-2 anemia during 2006 to 2007 in Kampala, Uganda. Study participants were randomly assigned to 1 of the 4 study arms and treated for 4 weeks as follows:  27 to the no erythropoietin (arm A); 25 to 2000 IU 3 times a week (arm B); 30 to 4000 IU once a week (arm C), and 26 to 2000 IU once a week (arm D). All the participants received oral hematinics. Hemoglobin was measured for all participants at baseline and at week 4. A self-administered baseline quality-of-life assessment using the SF-36 questionnaire was done for all and at week 4 for 60 participants. Changes in hemoglobin and quality-of-life scores were analyzed using SATA/IC 10 software.

Results:  The participants had a median age of 35±2 years, with 92 of 108 female participants. At week 4, there was a improvement of 1.73 g/dL (SE 4.03) in the hemoglobin in all the study arms. When compared with the "no erythropoietin" arm, unit hemoglobin level improvements were observed to be 2.22±2.20 g/dL (p <0.05) in arm B; 0.43±2.10 g/dL (p = 0.688) in arm C; and 0.27±2.18 g/dL (p = 0.806) in the arm D. Quality-of-life scores improved with hemoglobin scores in all the study arms, but physical vitality was significantly higher in study arm B (p = 0.017).

Conclusions:  Erythropoietin at a dose of 2000 IU 3 times a week is effective in improving the hemoglobin level of patients with grade1 to 2 anemia. This improvement exceeds that achieved with only oral hematinic supplementation.