RESEARCH ARTICLE
Trends in the Treatment of Anemia Using Recombinant Human Erythropoietin in Patients with HIV Infection
Patrick S Sullivan*, 1, 2, Debra L Hanson 1, James T Richardson 3, John T Brooks 1Author Comment: for the Adult/Adolescent Spectrum of HIV Disease (ASD) and HIV Outpatient Study (HOPS) Investigators
Article Information
Identifiers and Pagination:
Year: 2011Volume: 5
First Page: 113
Last Page: 118
Publisher ID: TOAIDJ-5-113
DOI: 10.2174/1874613601105010113
Article History:
Received Date: 4/9/2010Revision Received Date: 31/3/2011
Acceptance Date: 6/10/2011
Electronic publication date: 29/12/2011
Collection year: 2011
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
Abstract
Background:
Treating anemia with erythropoietin (EPO) to hemoglobin (Hb) endpoints >11 g/dL may increase risk of serious adverse cardiovascular events.
Methods:
We used medical records data (1996-2003 from the Adolescent Spectrum of HIV Disease Project [ASD] and 1996-2006 from the HIV Outpatient Study [HOPS]) to describe EPO prescription patterns for mildly, moderately, or severely anemic HIV-infected patients. We calculated proportions prescribed EPO and treated to Hb>12 g/dL, and tested for trends over time. We calculated median hemoglobin at first EPO prescription, and described temporal changes using linear regression.
Results:
Among 37,395 patients in ASD and 7,005 patients in HOPS, EPO prescription increased over time for moderately anemic patients; for patients with severe anemia, EPO prescription increased only among ASD patients. Hb at EPO prescription decreased over time in ASD patients (median=8.5 g/dL), but not in HOPS patients (median 9.5 g/dL). Percentage of EPO-treated patients with post-treatment Hb>12 g/dL was 18.3% in ASD and stable, and was 56.7% in HOPS and increased over time (p = 0.03).
Conclusions:
Through 2006, EPO prescription increased over time for patients with moderate or severe anemia. Many patients treated with EPO had post-treatment Hb>12 g/dL. Based on 2011 FDA recommendations, changes in previous prescription practices will be needed.
