AZT & Antiretroviral Treatments

AZT-Induced Anemia

Why Are People With HIV at Special Risk for Anemia?

There are different types of anemia, and different causes. Some types are temporary and have fairly simple causes. One cause of anemia is a diet that might include a shortage of certain vitamins and minerals, such as iron, vitamin B12, and folic acid. Anemia also can be caused by bleeding or blood loss. In fact, many women develop a mild form of anemia during menstruation. These are considered temporary, or acute, cases of anemia. They are relatively easy to bring under control.

In addition, certain drugs typically taken by people with HIV - like AZT and some chemotherapy drugs - also can cause anemia. That's why someone who is HIV+ is at a higher risk for becoming anemic. This is called treatment-related anemia, and it cannot be corrected by itself or through dietary supplements.

Why Do These Drugs Increase Risk for Anemia?

A common side effect of AZT is that your bone marrow has difficulty making red blood cells.

Antiretroviral Therapy / Combination Therapy

Antiretroviral therapy can help your immune system fight HIV by suppressing the virus and keeping your T-cell count raised. Each person reacts differently to the medications. Some of them experience side effects. Many are minor, but some can be debilitating. Often, these side effects go away after a few weeks. Some can last longer, but won't stop you from your daily activities. Often, HIV patients need intensive drug combination therapy - or a drug "cocktail" - to control their V-load

Why Do Antiretroviral Drugs Sometimes Stop Working?

When an antiretroviral drug begins to lose its effect, it is usually because the virus has developed resistance to the drug. Resistance occurs when certain changes in the virus make it less sensitive to a drug. HIV is particularly good at developing drug-resistant mutations. This is a major reason why the virus has been so difficult to eliminate.

Drug resistance can develop to any antiretroviral drug, especially when the drug is given alone instead of combined with other antiretrovirals. Resistance also occurs more frequently if a drug is not consistently taken according to the treatment schedule.

Combination Therapy

Why Do I Have to Take Several Antiretrovirals?

Shouldn't One Be Enough?

Using a combination of antiretroviral drugs has many advantages. First, combinations are more powerful than single-drug therapy because reverse transcriptase inhibitors and protease inhibitors interfere with viral reproduction in two different ways. Second, this approach makes it possible to combat HIV in different parts of the body. Although protease inhibitors are stronger than reverse transcriptase inhibitors, they are unable to penetrate the brain. Fortunately, some reverse transcriptase inhibitors, such as AZT, can reach brain cells. Combining protease inhibitors with a drug like AZT results in a powerful treatment that also attacks HIV in the brain.

Finally, a very important reason for using antiretrovirals in combination is that this strategy delays the development of resistance to any one drug. To prevent resistance, though, the drugs must be taken on schedule.

What Side Effects Should I Expect?

This is a very difficult question to answer. Each drug has its own side effects, and each patient responds to them differently. Some people experience no problems with a particular drug, while others are completely unable to tolerate it. Often, a person has no problem with an antiretroviral alone but has new or worse side effects when it is combined with other drugs.

The best way to get an idea of the side effects you may experience is to ask your doctor. You should make it your business to know what the negative effects of a drug may be and to use that information in deciding whether or not you wish to take the drug.

Keep in mind, though, that no one can predict for sure exactly how you will respond to a drug. And, even if the drug does have some side effects, your doctor may feel the benefits may be worth it.

Why Am I So Tired All the Time?

Antiretroviral medications often cause fatigue or tiredness. But if you are always tired, it also may be because you have anemia. People with anemia do not have enough red blood cells, which contain the hemoglobin needed to carry oxygen to the tissues of the body. Low levels of oxygen result in tiredness and little energy.

About 80% of people with HIV have some degree of anemia during the course of their disease. There are many reasons why anemia is so common in HIV-infected people. HIV itself can cause anemia. Also, many drugs used to treat people with HIV can reduce the number of red blood cells in the body. For example, AZT is a major cause of anemia in people receiving this drug.

Severe anemia can be life threatening. But even mild-to-moderate anemia can rob a person of energy and make it hard to live a normal life.

Can Anything Be Done About Anemia?

There are different ways to treat anemia. Severe anemia is usually treated with blood transfusions. But transfusion always carries the potential risk of infection or reactions. You also can make some changes in your diet and daily habits to deal with anemia. Your health care provider can give you tips on diet, conserving energy, and other ways to help you feel better. Another way of treating AZT-related anemia is with medication. Talk to your doctor about medications that can help with anemia.