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 (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.

* 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: Patrick.sullivan@emory.edu


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.

Keywords: HIV, anemia, erythropoietin..