CHICAGOOnce-a-week dosing of recombinant human erythropoietin
(epoetin alfa, Epogen, Procrit) is as effective as thrice-weekly dosing in
improving hemoglobin (Hb) levels in HIV-positive patients who are anemic,
Howard A. Grossman, MD, said at the Interscience Conference on Antimicrobial
Agents and Chemotherapy (ICAAC abstract 254).
Despite the overall improvement in the management of individuals infected
with HIV through highly active antiretroviral therapy (HAART), anemia
continues to be a major problem, said Dr. Grossman, associate attending
physician, St. Luke’s-Roosevelt Hospital Center, and assistant clinical
professor of medicine, Columbia University College of Physicians and Surgeons.
Even at mild or moderate levels, anemia reduces physical function and
undermines individuals’ perceptions of their physical, psychological, and
social well being. Yet treatment of anemia, particularly in its milder forms,
often is overlooked in HIV-positive individuals, he said
"Anemia has gotten lost in the blur of trying to do antiretroviral
therapy. But let’s face it; anemia is one of the main things physicians need
to treat, because fatigue is the biggest complaint of HIV patients," he
A number of clinical studies have shown that administration of epoetin three
times a week can improve the quality of life (QOL), halt progression of AIDS,
and improve survival of HIV-positive individuals. In studies involving surgical
and cancer patients, reducing the frequency of administration of epoetin to
once a week has been effective and well tolerated. Weekly dosing of the
medication has not been studied widely in HIV-positive patients, however.
"There are a number of benefits associated with weekly dosing,"
Dr. Gross-man said. "Once-a-week dosing lends itself to better adherence
and the possibility of direct observed dosing in the office. Another important
issue is reimbursement. Some insurance companies do not allow physicians to go
off label, so it’s important to prove that once-a-week dosing of
erythropoietin works for HIV patients."