Key points
- Anaemia is more common in people living with HIV, especially people with a low CD4 count.
- Anaemia can cause symptoms of tiredness and breathlessness.
- People living with HIV who have a low CD4 count sometimes also have other blood cell problems, including neutropenia and thrombocytopenia.
Blood contains different types of cells. These include red blood cells, platelets, and white blood cells.
CD4 cells are a type of white blood cells that play an important role in your immune system. If you have HIV and do not take HIV treatment, your CD4 cells count will reduce over time.
Apart from a decline in CD4 cells, the three most common blood cell problems among people living with HIV are anaemia, neutropenia, and thrombocytopenia. They are all detected using blood tests that you should have as part of your normal HIV care.
What is anaemia?
Anaemia is a condition that is caused by a problem with your red blood cells. If you have anaemia, it could be because:
- the amount of red blood cells in your blood is lower than normal
- you have abnormal red blood cells that can’t work properly
- the amount of haemoglobin (the part of the cell that carries oxygen) in your red blood cells is lower than normal.
Anaemia can cause symptoms of tiredness and breathlessness because there isn’t enough oxygen moving around your body.
Anaemia can have different causes. The most common cause is a lack of iron (iron deficiency anaemia). If you have low levels of iron, your body can’t make enough haemoglobin.
You might not have enough iron in your body because you are losing it through bleeding (for example, if you have heavy periods or piles). Alternatively, you might not be getting enough iron in your diet. This can be more likely for people who follow a vegetarian or vegan diet.
Iron deficiency anaemia is also common in pregnancy, because the amount of iron you need increases.
If you are diagnosed as having iron deficiency anaemia, your doctor may recommend changes to your diet or iron supplements.
Does HIV cause anaemia?
Anaemia is more common in people living with HIV. However, the risk of anaemia is much higher if you have a high viral load or if you are not taking HIV treatment, whereas it is lower for people with HIV taking effective HIV treatment. Anaemia can also be caused by some opportunistic infections, but if these are treated, the anaemia normally improves.
Can HIV medication cause anaemia?
Anaemia can be a side-effect of the HIV medication zidovudine, but this drug is rarely used now. If you are taking zidovudine and develop anaemia you may be able to change to a different medication.
HIV medications that are integrase inhibitors (such as dolutegravir and bictegravir) have also been linked to a higher risk of anaemia when compared to NNRTIs (such as doravirine and efavirenz) in some research, but more studies are needed to know for sure.&
Does HIV cause other blood cell problems?
Neutropenia (a shortage of neutrophils, a type of white blood cell) and thrombocytopenia (a shortage of platelets) are more common in people living with HIV, even if they are taking effective treatment. However, they are much more likely if you have a low CD4 count.
Some of these problems may be caused by damage to the bone marrow where blood cells are produced. They can also be caused by medication, for example, the anti-HIV drug zidovudine can cause neutropenia.