The prevalence of anemia in patients diagnosed with HIV is known to be high, and there are numerous causes that can be attributed to the former condition.
Autoimmune haemolytic anemia is one of these rarer causes which will be discussed further.
Autoimmune haemolytic anemia
Autoimmune hemolytic anemia is a condition where there is destruction of red blood cells as a result of an autoimmune reaction where the body produces proteins that attack these cells. The result is that the red blood cell levels in the body decrease because production from the bone marrow can’t keep up to the rate of destruction. This leads to symptoms of anemia such as pale skin, fatigue and shortness of breath, and patients can present with jaundice (yellowing of the white of the eyes and/or skin) and dark-colored urine.
Researchers are not entirely sure as to the reason why this autoimmune reaction occurs, with half of the cases being idiopathic, which means that no direct cause can be determined. However, various conditions have been thought to be secondary causes of the disorder.
These causes include other autoimmune conditions such as rheumatoid arthritis, lupus and scleroderma, as well as lymph-related cancers such as lymphoma in the warm subtype of autoimmune haemolytic anemia. The cold subtype is thought to be caused by respiratory infections such as viral pneumonia and mycoplasma, as well as the mentioned lymphoma.
The link between autoimmune haemolytic anemia and HIV
A study conducted on HIV-positive patients in 2014 discovered that autoimmune haemolytic anemia appears to be a complication of HIV infection. Of the participants in the study, more than 30 percent had clinical features of anemia, with nearly 10 percent of them being diagnosed with autoimmune haemolytic anemia.
HIV causes anemia in infected patients through various mechanisms. In the case of the anemia in question, HIV itself causes the formation of antibodies that attack and rupture the red blood cells.
This result demonstrates that autoimmune haemolytic anemia is a rare occurrence in HIV-positive patients, but the discovery of the diagnosis has a paramount impact on how the anemia is managed in these patients.
Treating autoimmune haemolytic anemia in HIV patients
A study in 2008 has documented how patients, who were infected with HIV and treated for anemia, received blood transfusions to manage the latter and ultimately had a poorer prognosis relating to the anemia.
These patients had autoimmune haemolytic anemia which was undiagnosed because they didn’t have a high reticulocyte count, which is usually present in patients with this type of anemia. The reason for the normal reticulocyte count was because HIV affects the way the bone marrow produced this type of cell.
Transfusing blood does not help manage autoimmune haemolytic anemia because new red blood cells are just being administered to these patients, and they end up being destroyed by the circulating antibodies in the patient’s bloodstream. The signs and symptoms of patients with autoimmune haemolytic anemia therefore won’t improve. In fact, blood transfusions in these patients may be potentially life-threatening to them.
Management of autoimmune haemolytic anemia
The management of autoimmune haemolytic anemia in HIV-positive patients includes reducing the viral levels,and suppressing the immune system in these patients so that there’s a reduced autoimmune response.
Reducing the immune system in an already immune-compromised patient may seem counter-intuitive, but prescribing antiviral medication to these patients helps to reduce the viral load of the HIV so that the body’s natural immune system can improve. Antiviral medications are prescribed for patients with low enough CD4 counts, in order to prevent antiviral resistance by starting too early with the medication.Corticosteroids are also indicated to reduce the autoimmune process that occurs.