CHICAGOOnce-a-week dosing of recombinant human erythropoietin(Drug information on 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 said.
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."