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

1 Centers for Disease Control and Prevention, Atlanta, Georgia, USA
2 Department of Epidemiology, Rollins School of Public Health, Atlanta Georgia
3 Cerner Corporation, Vienna, Virginia, USA

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© Sullivan et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Rollins School of Public Health, Emory Universtiy, 1518 Clifton Road NE, 4th Floor, Atlanta GA, 30322, USA; Tel: 404-727-2038; Fax: 866-311-8234; E-mail:



Treating anemia with erythropoietin (EPO) to hemoglobin (Hb) endpoints >11 g/dL may increase risk of serious adverse cardiovascular events.


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.


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).


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.

Keywords: HIV, anemia, erythropoietin..