Numerous studies have shown that anemia can occur in patients with HIV. Appropriate therapy for these conditions depends on the diagnosis.

Use of HAART to correct anemia in HIV-infected people.

The cohort studies described above have documented the efficacy of HAART for anemia in the majority of patients when used for more than six months.

The use of erythropoietin for the treatment of anemia in HIV-infected patients.

Decreased tolerance to erythropoietin (blunted response to erythropoietin) often accompanies HIV infection, leading to anemia requiring treatment. In a normal situation, with the development of anemia, an increase in the production of erythropoietin corrects it. However, in HIV infection, the normal compensatory response of erythropoietin to a decrease in the number of red blood cells is disrupted, resulting in an inability of the bone marrow to respond to an anemic condition. The mechanism for this disruption in erythropoietin production is a post-transcriptional defect in erythropoietin production, with a normal erythropoietin RNA molecule but reduced production of the normal erythropoietin protein. In addition, in HIV-infected patients, the development of autoantibody reactions to erythropoietin has been described, which leads to anemia. Multiple studies have now shown the beneficial effects of erythropoietin in HIV-infected patients with anemia, bone marrow suppression by HIV, or other chronic infections or inflammatory conditions.

Erythropoietin is also effective in treating anemia caused by zidovudine or other drugs, including bone marrow-suppressing anticancer chemotherapy drugs. The baseline level of serum endogenous erythropoietin determines in which patients to expect a response to the therapeutic use of erythropoietin. Patients with endogenous erythropoietin levels500 - no. Erythropoietin is administered subcutaneously at a dose of 100-200 mg/kg of body weight, three times a week until the level of erythrocytes normalizes, then once every one to two weeks the normal concentration of hemoglobin. Recent trials have demonstrated the equivalent efficacy of 40,000 units of erythropoietin once a week compared to three doses. Such appointments promise an increase in hematocrit, significantly reduce the number of red blood cell replacement transfusions, and significantly improve the quality of life. Recent data from the Spectrum of Disease Study and studies by Moore and colleagues have shown that correction of anemia is associated with improved survival. Erythropoietin toxicity is extremely rare, consisting mainly of local tenderness at the injection site, mild fever, and rash. However, in a control study, the data side effects observed with placebo.

Recently, a panel of AIDS specialists approved the use of erythropoietin in the treatment of anemia in HIV-infected patients. In patients whose endogenous erythropoietin level is less than 500 IU / L, and there is no response to drugs, provided that hidden deficiency of iron, B12, folate and other similar reasons are excluded.

The effect of erythropoietin therapy on the duration and quality of life.

As previously discussed, the Spectrum of Disease Study documented the likelihood of anemia in 36.9% of HIV-1 infected patients with clinical AIDS, 12.1% of patients with immunologic manifestations of AIDS (CD4+ cell<200 в мм3) и у 3,2% ВИЧ-инфицированных людей без каких-либо проявлений. Анемия ассоциирована с повышенным риском смерти при отсутствии других факторов. Риск смерти у анемизированных пациентов с уровнем CD4+ клеток<200 - на 148%, выше чем у тех CD4+клетки которых>200 in mm3, and in them, respectively, by 58% higher than in the observed non-anemic patients. Interestingly, the risk of death is 170% higher in patients with recurrent anemia than in those with persistent anemia.љ

The importance of treating anemia in HIV-infected patients was shown by Moore and colleagues who followed 2348 HIV-infected patients from 1989 to 1996. Among them, 21% developed anemia (Hb<94 г/л). Как и в исследовании Салливана с коллегами развитие анемии при условии контроля других прогностических факторов было связано с сокращением жизни. Примечательно, что применение эритропоэтина было причастно к снижению смертности.

It has also been demonstrated that treatment of anemia is always associated with improved quality of life. Studies have been completed regarding the quality of life of patients undergoing chemotherapy for oncology. So in a study of 2342 patients conducted by Glasby and colleagues, erythropoietin was prescribed 3 times a week for 4 months. Erythropoietin was effective in improving functional status and quality of life in anemic cancer patients in addition to its hemoglobin-raising effect. A second large study was conducted by Demetri and colleagues in 2289 anemic cancer patients who received chemotherapy with 10,000 units of erythropoietin 3 times a week for four months.

љA significant improvement in quality of life was found, directly related to an increase in the level of hemoglobin associated with erythropoietin. Interestingly, the improvement in quality of life is independent of response to chemotherapy, with clear improvement in both responders and non-responders to each specific chemotherapy regimen. Gabrilov and colleagues also showed a significant improvement in quality of life in 3012 patients with non-myeloid malignancy treated with 40,000-60,000 units of erythropoietin weekly. These data help to understand the importance of hemoglobin scores in improving the lives of cancer patients and the additional importance of hemoglobin scores in determining the standard of living in patients with HIV infection.

Several researchers have evaluated the effect of erythropoietin on anemia and the standard of living of patients with HIV. Abrams and colleagues surveyed 221 people in a community-based, multicenter, open-label study. Patients received zidovudine 4200 mg/week in addition to other antiretroviral agents and all had hemoglobin levels<110 г/л. В среднем уровень гемоглобина поднимался на 25 г/л. Более того, статистически значимое улучшение качества жизни было связано с улучшением уровня гемоглобина. Интересно, что положительная динамика не была связана с какими-либо изменениями уровняљ CD4+клеток. Еще ранее Ревиски и коллеги установили эффективность применения эритропоэтина в отношении уровня жизни у 251 пациента с ВИЧ-инфекцией и анемией (гематокрит<30%). Коррекция анемии при уровне гематокрита 38% и выше без дополнительных гемотрансфузий наблюдалась в течение 24 недель у 34% пациентов. Эти пациенты были в значительной мере удовлетворены уровнем своего здоровья, общим самочувствием, энергичностью и наблюдались амбулаторно. Также была показана эффективность еженедельного приема эритропоэтина в отношении уровня гемоглобина и объективного улучшения качества жизни в группе из 786 человек, получавших профилактическое лечение. В этом исследовании 75% пациентов отреагировали подъемом уровня гемоглобина как минимум на 10 г/л, с подъемом через четыре месяца среднем на 27 г/л.љ The mean Linear Analogue Scale (LASA) Quality of Life measure increased by 41%, while the MOS-HIV overall quality-of-life measure increased by 37%.

Potential role of Darbopoetin Alpha.

Darbopoietin alfa is known as a novel erythropoiesis stimulating protein (NESP) that acts on erythrocytes in the same way as erythropoietin, but differs in chemical structure. The additional presence of a sialic acid residue increases its half-life, which allows a reduction in dosage compared to conventional erythropoietin. Recent studies have established the effectiveness of NESP at a dose of 2.25-4.5 mcg/kg once a week in cancer patients, among whom approximately 70-80% of hemoglobin returned to normal levels. Another dosing regimen where NESP was administered every 2 or 3 weeks has also been found to be effective. There is currently no declaration on the use of NESP in HIV/AIDS. Multiple prospective studies are underway to determine the efficacy and toxicity of NESP in the treatment of anemia in HIV-infected patients. Results similar to those already demonstrated with recombinant human erythropoietin are expected.

The use of replacement blood transfusions in the correction of anemia in HIV-infected patients.

Blood transfusions play an important role in the management of acute blood loss, and intermittent transfusions are also necessary as symptomatic therapy for chronic blood loss or medical suppression of erythropoiesis. In a group of HIV-infected patients receiving replacement blood transfusions for 1-2 weeks, an increase in the levels of HIV-1 p24 antigen and HIV-1 RNA has been documented. An increase in opportunistic infections has also been documented in this situation. Importantly, HIV-infected patients receiving blood transfusions have an increased risk of death. A prospective study was recently conducted in 531 patients with HIV and CMS infections. RBC transfusions were randomized using a leukocyte filter and without a filter; an effect was established in each of them in relation to the plasma level of HIV-1 RNA, CD4+ cells, and cytokines. In addition, filter transfusions were found to be disadvantageous compared to unmodified ones. While there is no scientific justification for the pathological immunomodulatory effect of blood transfusions, observational data suggest the possibility of some of these effects, probably associated with an increased risk of recurrence of oncological processes or infection. Therefore, blood transfusion should be reserved for HIV-infected patients who need urgent correction of anemia in the presence of cardiovascular and other symptoms.

Serious deviations in the results of a complete blood test in HIV-infected people may not be observed for many decades. Such results can be achieved by regular use of combination drugs for antiretroviral therapy. Based on this, hemoglobin in HIV infection is normally no different from that of a healthy, uninfected person:

But do not ignore routine blood screening, because a decrease in the level of hemoglobin in the blood may indicate the development of anemia (the most common complication of the immunodeficiency virus). Anemia occurs in 8 out of 10 HIV-infected people, so even a slight decrease in hemoglobin should be a signal to contact a therapist. In most cases (if the level of iron-containing blood pigment has not fallen below 110/115 g / l), the situation can be easily corrected without the use of medications. It is enough to start eating foods that contain a large amount of iron. If hemoglobin still falls, then synthetic medicines are prescribed (folic acid, Ferroplekt, ferrous gluconate).

What ESR in HIV is considered the norm?

ESR (erythrocyte sedimentation rate) is normally 2-20 mm / h and increases when an infection or inflammation develops in the body. Some patients who are suspected of being infected with HIV believe that an ESR test will be enough to reassure themselves (or, conversely, to confirm the diagnosis). Indeed, an abnormally high erythrocyte sedimentation rate (about 50 mm/s) may indicate that a destructive virus has entered the body. However, it must be remembered that there are hundreds of other reasons that provoke an increase in ESR, including:

• heart attack;
• rheumatism;
• pregnancy;
• inflammatory diseases.

At the same time, the ESR in HIV infection in the latent period can be absolutely normal. However, we must not forget about periodic screenings. About what hemoglobin in HIV-infected people in combination with the ESR indicator indicates the progression of the disease, only the attending physician will tell. Indicators are calculated separately for each patient, taking into account the general state of health and the presence of concomitant symptoms.

Complete blood count for HIV: appointment and changes in indicators

Early diagnosis of HIV will reveal the presence of the human immunodeficiency virus in the blood even before the first signs of infection and the subsequent development of immunodeficiency appear. Today, experts know almost everything about HIV infection, and yet it is still possible to successfully fight the virus, prolonging the life of the patient, only if the process was taken under control at an early stage.

One of the most effective diagnostic methods is a complete blood count: with HIV, it will already at an early stage show the changes that occur as a result of the virus entering the human body.

What will the general blood test show?

Deciphering a complete blood test for HIV

A general blood test is a procedure familiar to everyone literally from childhood. Blood for research is taken from a small cut on the finger, and such an analysis will bring a minimum of discomfort. However, its result can tell a specialist about almost all processes in the body: a change in the number of certain blood cells is evidence of infectious and other diseases.

HIV - human immunodeficiency virus - primarily affects the cells responsible for immune responses, that is, for a person's ability to resist infections. That is why it is dangerous: if you do not stop or at least slow down the process, very soon the body will be defenseless against a variety of diseases.

A general blood test for HIV allows you to see the following changes:

• Lymphocytosis is an increased number of lymphocytes in the blood. It usually manifests itself at an early stage of the disease - this is how the body reacts to the penetration of the virus and tries to contain it on its own.
• Lymphopenia is a decrease in the number of lymphocytes. Usually it is a consequence of the development of a disease that impairs the functioning of the immune system.
• Thrombocytopenia is a decrease in the number of platelets in the blood - the cells responsible for blood clotting. Thrombocytopenia can lead to prolonged bleeding that will be very difficult to stop, and they can be not only external, but also internal.
• Neutropenia. This is called a decrease in the number of neutrophils - blood cells produced in the bone marrow. Usually, a decrease in their number is a consequence of infection, which may indirectly indicate the presence of HIV in the blood.

A decrease in hemoglobin due to a deterioration in the work of red blood cells. These blood cells are responsible for transporting oxygen to organs and tissues, so a decrease in hemoglobin can manifest as signs of anemia.

Atypical mononuclear cells can be detected in the blood - these are virocytes, that is, mononuclear lymphocytes produced by the body to fight viruses.

All these changes in the composition of the blood can indicate not only HIV, they can also manifest themselves in other infectious diseases. If the general blood test causes suspicion in the doctor, an additional examination for the presence of antibodies to the virus will be prescribed.

When can blood tests for HIV be ordered?

Ordering a blood test for HIV

An HIV blood test is often a precautionary measure. The infection may not manifest itself for more than 10 years, and often the infection is discovered by chance. Patients are referred for tests before elective operations in order to avoid sudden complications due to a decrease in the number of platelets and other blood parameters. Pregnant women need to undergo a mandatory examination: if the mother is infected with HIV, the virus will be transmitted to the child through the blood and breast milk, which over time will lead to the rapid development of secondary diseases.

It is necessary to take tests if the possibility of infection is not excluded: the virus is transmitted through the blood or other body fluids. If you had unprotected sex with an unverified partner, or if you had tattoos or piercings in a suspicious salon, it is advisable to get an examination to make sure everything went well.

Health workers and donors are also at risk: contact with infected blood is possible, and it is necessary to be examined as soon as possible after a dangerous situation.

The virus can be transmitted through non-sterile injection needles and surgical instruments. It is important to know that HIV is not transmitted through shaking hands, kissing, sharing objects. Although family members of the patient are also included in the risk group, the chance of becoming infected during normal everyday communication is very low.

You can learn more about the blood test for HIV from the video.

A general blood test is performed on an empty stomach in the morning, you should not take alcohol the day before and it is undesirable to eat spicy food. For examination in conventional laboratories, capillary blood is taken from a finger, and in clinics with modern equipment, blood is most often taken from a vein. The results can be known in a few days, and if they are doubtful, the doctor will prescribe an additional program of tests. A complete examination will reliably determine the presence or absence of HIV infection.

Possible symptoms of HIV

Symptoms of HIV infection

In the first few days after infection, an acute immune reaction to the penetration of the virus may occur. Symptoms most of all resemble the signs of a common cold: the temperature rises sharply, a headache, general malaise, swollen lymph nodes are possible. However, after a few days, the symptoms completely disappear, and the person stops worrying.

In the case of HIV infection, this only indicates that the disease has begun to progress, and the body itself is not able to cope with it. In the future, a long period may pass during which the disease may not manifest itself in any way.

Often, HIV tests are prescribed already when the first signs of a possible infection appear.

They indicate disorders in the functioning of the immune system, and the manifestations can be varied:

• The manifestation of several infectious diseases: these are herpes, pneumonia, tuberculosis, etc. Usually, traditional treatment does not work, since the body's immune system is unable to fight the disease.
• Sudden unreasonable weight loss, indicating a metabolic disorder. Simultaneously with a sharp weight loss, chronic fatigue and apathy are observed.
• Prolonged diarrhea, constant slight fever. These signs also indicate the presence of an infection that the body cannot deal with on its own.
• Sweating at night. This is a symptom not only of HIV, but also of many other infectious diseases.

The most reliable way to check your health is to get tested for HIV infection at the first suspicion. If the result is negative, it will be possible to look for other causes of ailments with a light heart, and if a virus is detected, the patient will receive medical recommendations that will help to significantly prolong life and improve its quality. It is possible to fight HIV infection, and advances in medicine make it possible to cope with almost all manifestations.

Diagnostic efficacy of complete blood count in HIV

Early diagnosis of HIV is of great importance. This will allow timely detection of the virus before the appearance of characteristic symptoms, the development of the disease. Modern medicine is actively fighting the virus, thereby prolonging human life. All this becomes possible with early diagnosis.

For these purposes, a general analysis for HIV is used. It shows changes in the body, is one of the most effective methods of qualitative diagnosis of the disease.

Advantages

By assessing blood parameters, a qualified specialist draws conclusions about a person’s health. With the help of this analysis, it is possible to study the disease in full, the state of the human immune system.

The study begins with the delivery of this analysis. Among the main advantages of this option are speed, low cost and performance.

It is important to know: according to a general blood test, you can determine whether you have HIV or not.

Changes in Outcomes with HIV Infection

The causative agent in the case of the study will not be able to identify. The indicators change.

• Lymphocytes are in an elevated state at the initial stage of the development of the disease. The immune system is fighting, the body is not exhausted. Due to the increased rate, lymphocytosis occurs.
• With the gradual development of the disease, a decrease in the number of lymphocytes is observed. The retrovirus is activated by a decrease in T-lymphocytes. In particular, the normal rate for an adult becomes 20 - 40%, for children more - 30 - 60%.
• The first to start fighting when infected are neutrophils, or granular leukocytes. Phagocytosis is activated, while neutrophils decrease in number. Diagnosis shows neutropetia.
• The main task of mononuclear cells is to destroy pathogenic microorganisms. In cases where a person is healthy, they will not be detected when evaluating the results of the analysis.
• Hemoglobin in this case will be lowered. This indicates anemia, or leukemia. There is an increase in the level of ESR.
• There is a decrease in platelets, which affect the clotting index. Because of this clinical picture, people with HIV suffer from internal and external bleeding.

So, does a general blood test determine HIV. This examination contributes to the diagnosis of infection, changes in indicators. The causative agent itself cannot be identified. Poor results will be the basis for further referral, more accurate diagnosis.

General blood analysis

Thanks to the analyzes, the doctor constantly monitors the patient, considers changes, and prescribes an effective course of therapy.

Patterns in the general blood test in HIV-infected people

If HIV is suspected, a general blood test is also prescribed. Depending on the results, the doctor refers the patient to additional procedures.

Violations in the indicators of leukocytes, against the background of changes in normal blood clotting, indicate abnormal development.

In the absence of symptoms of an infectious disease and an increased ESR, conclusions can be drawn about infection.

Indications

For a long time, the virus does not appear in the human body. This analysis is a kind of preventive security measure. If the diagnosis is confirmed, early diagnosis will positively affect the further well-being.

• In addition to the signs of the disease, an analysis is prescribed for people before planned operations. With the help of such a measure, the specialist fully assesses the state of blood coagulation. This helps to minimize the risk of bleeding, both during and after surgery.
• In the case of planning, or the state of pregnancy that has already begun, an analysis is necessary. In the future, when feeding a child, when HIV is confirmed, the fetus becomes infected. When passing through the birth canal, there is a high probability of infection of the baby.
• When you receive blood from another person, you are given a complete blood count.
• This procedure is necessary after a tattoo, piercing in a place with non-sterile conditions.
• Most often, the examination is necessary after unprotected sexual contact with an unfamiliar person.
• Workers in the field of medicine are at increased risk, because they constantly work with objects of a surgical nature.
• With certain body signals, pathologies, experts recommend taking a general blood test.

Symptoms

Symptoms of the disease resemble the onset of a common cold infection. This condition is characterized by fever, severe headaches, fatigue and malaise. After a short period of time, the symptoms disappear, the person forgets about the recent manifestations.

There are violations in HIV infection in the work of the immune system:

In order to check your health, you need to take a general blood test. If the result is negative, you can look for another reason for such symptoms. When an infection is confirmed, a person not only diagnoses the disease in time, but also prolongs his own life.

Modern medicine shows success in the treatment of manifestations of HIV.

Rules for the procedure in HIV-infected people

When infected, it is important to remember the frequency of the test. Once a quarter, a person undergoes this procedure. This helps to monitor the dynamics of the development of the disease, to make adjustments to the treatment process, depending on its effectiveness.

If it is necessary to take not only a general blood test, but also other tests, one blood sampling is possible, for example, from a vein. With this combination, it is important to clearly define the place of blood sampling. Either from a vein, or from a finger.

In order for the effectiveness of the analysis to be accurate, it is necessary to refrain from eating 12 hours before the test. Of great importance is the laboratory institution in which the procedure takes place. It is best to take the analysis in one place, with the same conditions. Thus, the specialist will receive more correct data. Timing is also a factor in donating blood. Choose for yourself a specific period when the procedure will take place.

When donating capillary blood from a finger, you should use a lancet. Its advantage lies in a fairly sharp, thin needle. Using the scarifier, the patient feels pain. This condition is characteristic, because at the end of the finger there are nerve endings. The cost of a lancet is more than a scarifier.

conclusions

In cases of HIV infection, early diagnosis is important. A general blood test is a way to carry it out.

This procedure is distinguished by its availability, high efficiency, speed of implementation. This preventive measure will help to control the state of your health, to detect the disease in time.

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Does a complete blood count show HIV infection?

Early detection of the disease in a person plays an important role in the diagnosis of HIV. For this, there are tests by which infection can be detected. Will a complete blood count show AIDS and HIV? Of course, it is impossible to make a diagnosis based on this study alone; other highly specific examinations will be necessary.

However, in a detailed analysis, there are some indicators whose changes are highly indicative of infection with this virus. Let's talk about whether a general blood test can be normal if a person is infected with HIV infection.

Why is a complete blood count ordered?

Any disease that occurs in the human body, one way or another, is reflected in the qualitative and quantitative composition of its biomaterials. And a complete blood count or KLA for HIV is no exception. The main objective of this clinical study is to determine the state of the human body's immunity, which changes significantly when affected by HIV infection.

CBC is the initial screening method for examining patients for virus infection. Its advantages:

• low cost of the study;
• quick results;
• changes in the biomaterial are very indicative in the presence of infection.

Thanks to this study, it is possible to draw a conclusion about the state of a person’s health and either send him to a further stage of examination, or make a diagnosis of “Healthy”.

Blood tests for HIV may be ordered in the following cases:

1. When admitted to a hospital for planned surgery. At the same time, it is necessary to donate blood in order to minimize the risk of infection of medical personnel. Operations on HIV-infected people are carried out with increased protection measures.
2. When pregnancy occurs or in the process of its planning. For pregnant women, the rate of testing for HIV is three times for the entire period of gestation. This is done to prevent infection of the fetus in utero, during childbirth and during breastfeeding. In all these cases, the virus can be transmitted to the child.
3. If there are signs of other infectious diseases specific for the concomitant HIV infection. These include: pneumocystis pneumonia, herpes infection, tuberculous lesions of internal organs.
4. After a possible infection through unprotected sexual contact. To do this, a person independently turns to the clinic, where he is examined in conditions of complete anonymity.
5. Also, according to a blood test from a vein, HIV can be detected if a person has signs of a violation of metabolic processes in the body. These include: a sharp emaciation, apathy, constant fatigue, sweating at night, periodic causeless increase in body temperature up to 37.5 ° C, diarrhea.
6. Diagnosis of AIDS by routine blood testing is carried out annually in health care workers who have direct contact with patients' bodily fluids.

In all of the above situations, regardless of what the general blood test shows, it is necessary to conduct specific studies for HIV: ELISA or immunoblot.

Patterns and changes in the CBC in HIV-infected people

The direct causative agents of HIV cannot be determined in the general blood test, but some signs of the development of infection can be determined.

Consider what can be learned from the decoding of a blood test when infected with the immunodeficiency virus.

Lymphocytes

The normal content of these cells is 25-40% or 1.2-3×109/L. At the beginning of the development of the disease, an increase in this indicator is observed, due to the increased struggle of the body with a viral infection. When the disease began to progress and completely affected the human immune system, a critical decrease in lymphocytes in the blood was detected. This phenomenon is called lymphopenia and affects mainly the fraction of T-lymphocytes in HIV.

Neutrophils

This type of white blood cell begins to activate immediately after infection with the virus. At the same time, neutrophils start the process of phagocytosis, which is subsequently expressed in a decrease in their number - neutropenia. The norm of the content of these granular cells is 45-70% or 1.8-6.5 × 109 / l. A decrease in the number of neutrophils in the blood is not particularly specific for HMC infection, since this phenomenon is observed in all infectious and inflammatory diseases.

mononuclear cells

These abnormal cells are a type of white blood cell. In fact, these are lymphocytes that have one nucleus. Mononuclear cells appear in the analysis when infectious agents (viruses or bacteria) enter the body. Normally, these immune cells should not be present in the biomaterial.

platelets

These cells play an important role in the processes of coagulation. Normally, an adult has from 150 to 400 × 109 / l of platelets. When infected with HIV, there is a significant decrease in the total number of platelets. Clinically, this is manifested by the development of various types of bleeding: internal, external, the occurrence of petechiae (small rash on the skin) and hemorrhages on the mucous membranes.

red blood cells

This indicator is not so specific for infection with the human immunodeficiency virus. Red blood cells most often with this pathology tend to decrease in number. This happens due to the influence of the virus on the bone marrow, in which blood formation occurs. The norm is the content of erythrocytes in biomaterials in the amount of 3.7-5.1 × 1012/l.

However, sometimes, in the KLA with immunodeficiency, an increase in the number of red blood cells is detected. This phenomenon occurs in pulmonary diseases associated with the development of HIV infection. These diseases include: pneumonia and tuberculosis.

Hemoglobin

Often with HIV / AIDS, a decrease in hemoglobin levels is detected, which indicates the development of iron deficiency anemia. This iron-containing protein is found on the surface of red blood cells and helps deliver oxygen to all cells in the body. With a decrease in its amount, tissues begin to suffer from a lack of nutrition. Clinically, anemia is manifested by weakness, dizziness, pale skin, and increased heart rate. Normally, hemoglobin in men should be otg / l, in women - g / l.

Sedimentation rate of erythrocytes

When infected, there is a significant quantitative excess of this indicator. Normally, in men, the ESR is from 1 to 10 mm / h, in women - from 2 to 15 mm / h. This criterion is specific for viral damage, if there are no signs of any other infectious and inflammatory processes in the body. An increase in ESR is associated with an increase in blood viscosity and increased adhesion of red blood cells to each other.

As we can see, a general blood test does not allow 100% to identify the presence and determine the stage of development of HIV. However, this research method is an indisputable assistant for doctors at the initial stages of diagnosing a disease.

Can a general blood test show HIV: what indicators indicate a virus

More recently, the human immunodeficiency virus was the plague of the 20th century. Finding out about such a diagnosis was akin to a death sentence. To date, medicine has stepped far in the study of this virus. The very first and most important step towards the early diagnosis of the disease is a complete blood count for HIV, more precisely, if this disease is suspected. A general blood test is able to detect changes in the qualitative composition of the biomaterial even at the earliest stages of pathology.

Any changes and deviations are the reason for additional research in order to refute or confirm the diagnosis.

Complete blood count for suspected HIV

The following is known about the human immunodeficiency virus: it affects the body's immune cells, which gradually stop working, and, as a result, the body can no longer cope with infections. Works slowly but surely. Destroying immune cells, it gradually leads the body to inevitable death. It doesn't have to happen today or tomorrow. Life expectancy depends on how soon the signs of the disease are detected and measures are taken to eliminate them.

A complete blood count will not give you an accurate diagnosis, but will show any changes that have occurred in your serum material. They will be the starting point on the way to diagnosis and treatment.

HIV is an infection, the last point of which is AIDS. Accordingly, a complete blood count for suspected HIV infection will help your doctor provide a clear picture of your health.

In this regard, people ask the question: which blood components change their qualitative and quantitative composition in AIDS.

Only a special analysis can show HIV infection. Today, in pharmacies, you can even buy a home version of such a study. Let's talk about the general blood test. How to decode it to find out your HIV status.

The reverse process, when the number of lymphocytes drops sharply, indicates that the body can no longer cope with the disease on its own, since immune cells practically do not work. In this case, lymphopenia is diagnosed.

Of course, such changes can be signs of absolutely any infectious diseases. Only additional special tests will be able to accurately detect HIV. They will be prescribed by a doctor if they suspect something is amiss.

In case of infection with the immunodeficiency virus and with a confirmed diagnosis, a blood test for HIV is taken every three months. This is the only true and informative way to track the patient's condition.

Who and when is an HIV blood test ordered?

We have already said that this virus may not show its signs for quite some time. People live for decades without knowing that they are carriers of a terrible disease. Therefore, if HIV is suspected, a clinical blood test is more likely a preventive measure. It is good if the patient's negative HIV status is confirmed, otherwise, early diagnosis will be the key to a successful course of the disease. Taking into account all possible measures to support such patients.

So, the indications for taking a general blood test for HIV infection are:

• planned operations. This analysis will focus not so much on the process of identifying signs of the immunodeficiency virus, but on the state of platelets before surgery. This measure will help assess the situation with blood clotting and avoid unexpected bleeding during and after surgery.
• pregnancy planning or already occurring pregnancy. HIV infection adversely affects the prenatal state of the fetus up to serious congenital pathologies. It is important to know that a woman who is infected with AIDS and is breastfeeding her baby is passing on her disease to him. In addition, passing through the birth canal of an infected mother, the child is at risk of infection.

• it is necessary to pass the analysis after unprotected sexual contact with a person in whom you are not sure;
• if you got yourself a tattoo or got pierced in a dubious tattoo parlor;
• in the case of blood donation to you from someone;

It is better to make sure once again that everything is normal than to be treated later for a terrible and painful disease.

In addition, medical workers and people who deal with non-sterile needles and surgical instruments are at increased risk.

Various body signals also indicate the need for this study.

Signs of HIV

Changes in well-being should be the first bell to go to the doctor. No one argues that it can be simple fatigue or a beginning acute respiratory disease. However, it is not uncommon for the immunodeficiency virus to be hidden by chronic fatigue and nervousness.

HIV symptoms:

• Temperature, chills, swollen lymph nodes, headaches. In a word, many manifestations of the common cold. In most cases, these symptoms pass quickly, the person feels healthy and alert, not suspecting that the disease has already begun to progress.
• Tuberculosis, pneumonia, herpes. Most often, these diseases occur simultaneously. HIV in this case can be determined by the futility of the prescribed treatment. The therapy does not give results, because the human immune system is completely "eaten" by the virus and no longer performs its protective functions.
• Sudden weight loss combined with apathy, loss of appetite. Sometimes all this is accompanied by fever and diarrhea. All these are indicators of a serious infection that the body can no longer cope with on its own.

Research Methods

You can detect the immunodeficiency virus by passing a narrow-profile analysis for HIV status. Blood will be examined in two main ways:

1. enzyme immunoassay

The first option is the most informative. With it, it is possible to determine the presence of a virus in the body even 1.5 - 2 months after it enters the cells and tissues. The presence of antibodies to immunodeficiency is determined. No antibodies, no virus. The result may be influenced by the time of infection. Usually the virus is activated within 2-3 months, but sometimes the periods increase and a “window” appears, in which it is impossible to obtain a reliable result.

As a rule, a second AIDS test is scheduled after six months.

Complete blood count for HIV

HIV infection is a disease caused by the immunodeficiency virus. The pathology is characterized by the development of various secondary infections and all kinds of malignant neoplasms. These violations occur as a result of large-scale dysfunction of the immune system. HIV infection can last from several months or even weeks to decades. Then the disease takes the form of AIDS - directly acquired immunodeficiency syndrome. Lethal outcome in the absence of AIDS therapy occurs within 1-5 years.

The disease at its various stages is diagnosed using several studies:

• screening test - detection of antibodies to the virus in the patient's blood using enzyme immunoassay;
• polymerase chain reaction;
• tests for immune status;
• viral load tests - this procedure is carried out with a positive screening test.

Complete blood count for HIV

In addition, the immunodeficiency virus adversely affects the work of all body systems. As a result, the development of an infection in a patient is evidenced, for example, by the results of a clinical blood test.

Attention! A clinical blood test does not reveal the presence of HIV infection or AIDS in a patient. However, if a person has multiple abnormalities during diagnosis, he is recommended to be tested for the presence of antibodies to the virus.

Features of the course of pathology

The human immunodeficiency virus is a member of the retrovirus family. Once in the patient's body, it provokes the development of a slowly progressive disease of HIV infection, which gradually takes on a more severe and difficult to treat form - AIDS.

Attention! AIDS is a complex of diseases that occurs in people with a positive HIV status. The pathological process develops as a result of disturbances in the functioning of the immune system.

After penetration into the body, the infectious agent is introduced into the vessels. In this case, the virus attaches to the blood cells responsible for the reactive function, that is, for the functioning of the immune system. Within these uniform elements, HIV multiplies and spreads to all human organs and systems. To a greater extent, lymphocytes suffer from pathogen attack. That is why one of the characteristic signs of the disease is long-lasting lymphadenitis and lymphadenopathy.

Virus entry into the cell

Infectious agents over time are able to change their structure, which does not allow the patient's immunity to timely detect the presence of the virus and destroy it. Gradually, the functioning of the immune system is increasingly inhibited, as a result of which a person loses the ability to defend himself against various infections and various pathological processes in the body. The patient develops various disorders, there are complications of even the mildest diseases, for example, acute respiratory infections.

Attention! In the absence of therapy, secondary, that is, opportunistic, diseases can lead to death 8-10 years after the virus enters the human body. Properly selected treatment can prolong the life of the patient.

Routes of HIV infection

HIV symptoms

With the development of HIV infection, the patient begins to worry about the following symptoms:

• rashes on the skin, stomatitis, inflammation of the epithelial membranes;
• lymphadenitis, with the transition of HIV to AIDS, lymphadenopathy develops - the defeat of most of the lymph nodes in the patient's body;
• nausea and vomiting;
• loss of appetite and weight, anorexia;
• myalgia and cephalgia;
• sore throat, tonsillitis;
• cough, shortness of breath;
• the appearance of plaque on the tongue and in the throat;
• stool disorders, tenesmus - painful urge to defecate;
• increased sweating;
• decreased vision.

The body's first signals of HIV infection

Initially, the patient may experience only one of the above symptoms. As the pathological process develops, the number of characteristic signs of HIV infection increases.

Complete blood count for HIV infection

In some cases, patients seek help from a specialist with complaints of frequent colds, weakness and drowsiness, a general deterioration in well-being, etc. In this case, the doctor prescribes various studies, including a general blood test. The identification of significant deviations from the norm in this case is the reason for the mandatory screening test for HIV.

Clinical blood test

A general or clinical blood test is a diagnostic procedure performed in the laboratory. This study allows you to obtain information about various blood parameters: the number of erythrocytes, leukocytes and platelets; erythrocyte sedimentation rate, hemoglobin content, etc.

Why take a clinical blood test

Clinical study of blood parameters (normal)

Attention! Clinical analysis is one of the most commonly used. It is prescribed both to assess the general condition of the patient during a preventive examination, and to confirm or exclude a preliminary diagnosis.

Clinical blood test

With the help of this study, it is possible to identify a number of pathologies: diseases of a bacterial, fungal and viral nature, inflammatory processes in the patient's body, malignant tumors, anemia and other disorders in the functioning of the hematopoietic organs, helminthiases, etc. When conducting a general blood test, a specialist has the opportunity to obtain information about the following indicators:

1. Erythrocytes are red blood cells. Their main function is to carry oxygen and carbon dioxide. An increased number of red blood cells may indicate the formation of carcinomas, polycystic kidney disease, Cushing's disease, etc. A lack of blood cells is a sign of overhydration, pregnancy, or anemia.

When making a diagnosis and prescribing further examinations, the doctor takes into account both the blood test results and the results of the patient's physical examination, his complaints and anamnesis.

Blood counts for HIV infection

Clinical analysis makes it possible to see the following changes in blood counts in an HIV-infected person:

1. Leukocytosis is an increase in the level of leukocytes in the blood plasma. At the same time, the specialist pays attention not only to the indicator of the absolute number of leukocytes, but also to the ratio of all their types. Lymphocytosis is most common in people with HIV infection. This is a pathology in which the content of lymphocytes in the peripheral bloodstream increases. Such a violation is noted in patients in the early stages of infection. By producing more white blood cells, the body tries to stop the spread of the virus through various systems. Leukocytosis may also indicate the development of various infectious and inflammatory processes. To accurately determine the cause of this violation, it is necessary to conduct a comprehensive examination.
2. Lymphopenia is a decrease in the level of lymphocytes in the patient's blood. In patients with HIV infection, the pathogen infects CD4 T cells, a type of lymphocyte. Also, lymphopenia can develop as a result of a decrease in the production of lymphocytes due to the dysfunction of the lymph nodes that has developed in the patient. If the virus has spread throughout the body, then the patient develops acute viremia. This condition leads to accelerated destruction of lymphocytes and their excretion into the respiratory tract.

How HIV infects cells in the body

The composition of the blood in anemia

Attention! During diagnostics, atypical mononuclear cells - lymphocytes, which the patient's body produces to fight various viruses, including HIV infection, can be detected in the patient's tests.

It is worth considering that these violations of blood counts may indicate the presence of not only HIV infection, but also a number of other pathologies. Therefore, a clinical blood test is not a specific method for detecting immunodeficiency virus. To make a diagnosis, the specialist must prescribe additional tests.

How to prepare for analysis

Blood sampling for clinical research is carried out mainly from 7 to 10 am. Before the analysis, approximately 8 hours before the diagnosis, it is necessary to refuse to eat food, exclude coffee, tea and alcohol from the diet. It is allowed to drink non-carbonated water immediately before the study. Excessive physical and mental stress can also adversely affect the results of the study.

How to prepare for a blood test

Attention! If you are taking any pharmacological drugs, you must inform the specialist. Many medications can affect blood counts.

If the patient does not follow the rules for preparing for the test, the results of the study may be unreliable. If the obtained indicators deviate from the norm, the doctor prescribes a second diagnosis.

A general analysis gives an idea of ​​the various parameters of the blood. It does not accurately detect HIV infection in humans. However, deviations in indicators indicate the development of a pathological process in the patient's body and are an indication for a specific analysis of a screening test for HIV.

Hematological disorders detected in HIV infection are not the leading clinical symptoms in the picture of the disease. However, the severity of these changes indicates a severe progressive course of infection. Changes pictures of peripheral blood in HIV infection depends on the stage of the disease. The most distinct violations are observed in the late stage of the disease. Changes in the peripheral blood picture, namely, neutropenia, anemia, thrombocytopenia, may occur in patients with HIV infection

In HIV-infected a nemia can have serious consequences: a decrease in the quality of life, progression of the underlying disease, worsening prognosis and survival. Some factors contributing to anemia are vitamin B12 and folic acid deficiencies, iron, protein, and rarely, pyridoxine, copper, and selenium deficiencies. Iron deficiency can develop due to insufficient dietary intake, latent blood loss through the gastrointestinal tract, and repeated blood sampling from the patient. The cause of anemia is the accelerated destruction of red blood cells (hemolysis).

The development of neutropenia usually coincides with the appearance of opportunistic (attached due to weakened immunity) infections and is exacerbated by the use of drugs used in the treatment of these infections.

Quite frequent and the only manifestation of hematological changes in HIV-infected patients may be thrombocytopenia, whichin HIV-infected may be due to autoimmune aggression. The disease occurs quite early, when the number of lymphocytes still exceeds 200 per µl. Normalization of the platelet count usually precedes the development of AIDS. Severe bleeding is rare.

Symptoms: decrease in hemoglobin in the blood, decrease in white blood cells, decrease in platelets in the blood

DIAGNOSTICS

Examination of HIV-infected people with anemia begins with a thorough history taking and physical examination. Important information about medications taken, diet, persistent fever, weight loss, bleeding, and the presence of symptoms of hemolysis (jaundice, dark urine).

Examination of patients with neutropenia begins with anamnesis, asking in detail about the signs of infections, nutrition and medications taken. On examination, pay attention to the symptoms of infections, an increase in lymph
fouzles, liver and spleen. Cultures and serology are helpful in diagnosing infections (particularly those caused by mycobacteria, cytomegalovirus, Epstein-Barr virus, parvovirus, and fungi).

In thrombocytopenia, in addition to the usual histological examination of a bone marrow biopsy, it is necessary to inoculate on media for fungi and acid-fast bacteria. Investigate blood coagulation factors (prothrombin time, fibrinogen).

Laboratory studies: clinical blood test, biochemical blood analysis. Studies conducted to diagnose HIV infection (detection of antibodies to the virus), bone marrow examination.

It should be distinguished: hematological manifestations of HIV infection, gastrointestinal bleeding, toxic effects of other and unspecified substances, secondary malignant neoplasm of bones and bone marrow
Medical procedures performed in the case of hematological manifestations of HIV infection: Clinical blood test, Biochemical blood test, Bone marrow biopsy, Comprehensive examination programs. Biochemical diagnostics of anemia: Iron, FBC, Transferrin, Ferritin, Vitamin B12, Folates, Erythropoietin, Serology, Blood cultures on nutrient media

PROGNOSIS AND COMPLICATIONS

Forecast.On average, from the onset of infection to the terminal stage, HIV infection lasts 10-15 years and is clearly correlated with the level of viremia. But in some cases, the disease is transformed into AIDS within months, in others - for many years. There are 3 types of the course of the disease: typical progression, rapid progression and no progression.

TREATMENT AND PREVENTION

Treatment. If possible, stop drugs that suppress erythropoiesis. With iron deficiency anemia, iron preparations are prescribed, with a deficiency of folic acid and vitamin B12, appropriate preparations. Treat opportunistic infections. When erythropoiesis is inhibited, normal immunoglobulin, erythropoietin, is administered intravenously. With life-threatening anemia, as well as with clinically pronounced anemia that cannot be treated, red blood cell transfusions are performed (preliminarily checked for the absence of cytomegaloviruses). With neutropenia, if possible, reduce the dose of the main treatment for HIV, treatment of opportunistic infections and oncological diseases. With thrombocytopenia during bleeding, platelet mass and plasma are transfused.

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Prevalence

Anemia is common in HIV-infected individuals, accounting for approximately 30% in the initial asymptomatic stage of infection, and rises to 80-90% during the course of the disease. In an attempt to determine the exact cause of anemia in HIV-infected patients previously treated with HAART, Sillivan and colleagues evaluated data from 32,867 case histories of HIV-infected individuals treated from January 1990 to August 1996. The HIV Surveillance Program includes two groups - adults and adolescents, consists of individuals undergoing HIV treatment in hospitals and HIV clinics in 9 major US cities, it is founded by a treatment and prevention center. Defining anemia as a decrease in hemoglobin below 100 g/l, or clinical manifestations of anemia, the researchers concluded that anemia lasting for a year can be regarded as the result of HIV infection. Anemia lasting a year accompanies 37% of patients with clinical manifestations of AIDS, occupies 12% of patients with immunological manifestations of AIDS (such as a decrease in the level of CD4+ cells to 200 mm3 in the absence of AIDS-specific clinical conditions), and 3% of patients among HIV- infected, without any clinical and immunological manifestations of AIDS.

These data indicate a high incidence of anemia among HIV-infected patients at all stages of the disease before the use of HAART. Thus, more recently, the use of HAART has been associated with a reduction in the frequency and severity of anemia.

Etiology of Anemia

Anemia associated with decreased production of red blood cells

Decreased RBC production may result from CFU-GEMM suppression factors such as inflammatory cytokines or HIV itself. Decreased erythropoietin production can also be documented in anemic HIV-infected patients. Similar suppression may occur in other infections and inflammatory processes. In HIV-infected patients with anemia, the presence of antibodies to erythropoietin has been described. Tumor infiltration of the bone marrow (eg, in lymphoma) or infection (such as Mycobacterium avium complex (MAC)) may also be leading causes of reduced RBC production. In addition, MAC may be associated with cytokine-induced bone marrow suppression. Involvement of the gastrointestinal tract in various infectious or tumor processes can cause chronic blood loss, with possible iron deficiency anemia. Another apparent cause of hypoproliferative anemia in HIV-infected patients is the large number of drugs, many of which can suppress bone marrow and/or red blood cells. Zidovudine (AZT), one of the drugs often associated with microcytosis (mean red blood cell volume > 100 fl), can be used as an objective indicator that a patient may experience complications from treatment. Anemia requiring replacement transfusion therapy (hemoglobin below 85 g/l) is observed in approximately 30% of AIDS patients who received zidovudine at a dose of 600 mg/d. However, severe anemia occurs in only 1% of asymptomatic patients taking zidovudine. It should be noted that despite the fact that stavudine is also associated with erythrocyte microcytosis, there is no threat of anemia when taking this drug.љ

Another cause of hypoproliferative anemia in HIV-infected patients is infection of the bone marrow with parvovirus B19 (infection at the level of early erythrocyte precursors - pronormoblasts).

Thus, bone marrow failure in relation to red cells, platelets, and neutrophils has been described in association with parvovirus B19. It may be pure anemia with no or minimal thrombocytopenia and neutropenia. Parvovirus infection is usually acquired during childhood and is one of the five most common childhood exanthems. Known antiviral antibody response with the development of late resistance to infection. Approximately 85% of adults had serological evidence of past parvovirus infection. However, the serological prevalence of such antibodies among HIV-infected patients is only 64%. This indicates the inability of these individuals to maintain adequate humoral immunity, which leads to the reactivation of latent infection. Parvovirus (B19) infection can be diagnosed based on the detection in the bone marrow of giant pronormoblasts with accumulation of basophilic chromatin and light cytoplasmic vacuoles. The diagnosis can be confirmed by FISH using specific DNA tests for parvovirus B19. Therapy for erythrocyte aplasia induced by parvovirus is infusion of intravenous gamma globulin. Gammaglobulin contains antibodies from the plasma of many donors, most of whom have been exposed to parvovirus. Infusion of these antibodies is able to neutralize the virus and restore normal hematopoiesis. Relapse of anemia induced by B19 parvovirus requires re-treatment.

The incidence of anemia in HIV-infected patients. (Table 1)

Cause of anemia	mechanism
Decreased RBC production (low reticulocytes, normal or low free bilirubin)	A) neoplastic infiltration of the bone marrow Lymphoma Kaposi's sarcoma Lymphogranulomatosis · Other B) infections Mycobacterium avium complex Mycobacterium tuberculosis Cytomegalovirus B19 parvovirus fungal infection · Other C) drugs (see table 2) D) direct action of HIV Abnormal growth of VOE-E Anemia of chronic disease · Violation of the production and / or use of erythropoietin. E) iron deficiency anemia due to chronic blood loss.
Inefficient production (low reticulocytes, high conjugated bilirubin)	A) folic acid deficiency Alimentary Pathology of the jejunum. Malabsorption B) B12 deficiency Malabsorption in the ileum Pathology of the stomach with a decrease in the production of intrinsic factor · Production of antibodies to intrinsic factor, for example in pernicious anemia.
(increased levels of reticulocytes and indirect bilirubin)	A) hemolytic anemia with a positive Coombs test. C) hemophagocytic syndrome. C) thrombotic thrombocytopenic purpura D) disseminated intravascular coagulation E) drugs. sulfonamides, dapsone Oxidants in patients with glucose-6-phosphate dehydrogenase deficiency.

hemolytic anemia.

Increased RBC destruction can be seen in HIV-infected patients with glucose-6-phosphate dehydrogenase (G6PDH) deficiency who have been exposed to oxidants and in HIV-infected patients with DIC and TTP. In the last two situations, thrombocytopenia and fragmented erythrocytes are observed in the peripheral blood smear, Heinz bodies are observed in association with G6PD deficiency. A hemophagocytic syndrome has also been described in association with HIV, with significant phagocytosis of erythrocytes by bone marrow macrophages. In addition, the destruction of erythrocytes, leading to anemia in HIV-infected patients, is due to the production of autoantibodies with a positive Coombs test and reduced erythrocyte resistance. Interestingly, the presence of antibodies on the erythrocyte membrane (positive direct Coombs test) is reported in 18% to 77% of HIV-infected patients, despite the fact that hemolysis or destruction of erythrocytes is negligible. Anti-i antibodies and antibodies against anti-U antigens are described in 64% and 32% of HIV-infected patients, respectively. A high incidence of positive direct Coombs test can also be found in patients with other hypergammaglobulinaemic conditions, which, however, indicates a secondary positive direct Coombs test in polyclonal hypergammaglobulinemia, which is known to occur in HIV infection.

Anemia associated with inefficient production of red blood cells (B12 and/or folate deficiency anemia)

Folic acid is absorbed in the jejunum and is responsible for carboxylation during DNA synthesis. FA deficiency results in megaloblastic anemia with large, oval, erythrocytes in the peripheral blood, hypersegmented polys, and abnormalities in all three hematopoietic lines, resulting in anemia, neutropenia, and thrombocytopenia. Folic acid is found mainly in green vegetables and is unstable in heat. Because tissue stores of folate are relatively small, a dietary deficiency of 6-7 months can lead to anemia. Thus, it is clear that HIV-infected patients who cannot eat well, as well as patients with jejunal insufficiency, are not able to absorb the required amount of folic acid. This inadequate absorption can lead to anemia, neutropenia and thrombocytopenia. In folate deficiency anemia, the level of reticulocytes is low, however, unbound bilirubin is increased. MCV of erythrocytes is high. The classic changes in megaloblastic anemia are found on bone marrow examination, with low erythrocyte and serum folate levels.

Ineffective erythropoiesis, blood pancytopenia, elevated free bilirubin, and low reticulocytes are also seen in vitamin B12 deficiency. In the stomach, vitamin B12 binds to intrinsic factor secreted by parietal cells, then the B12+intrinsic factor complex is absorbed in the ileum. Thus, malabsorption of B12 can easily develop in various gastric disorders (eg, achlorhydria), in the production of antibodies to parietal cell intrinsic factor ("pernicious anemia"), or in various disorders of the small intestine and ileum (infections, Crohn's disease). Thus, it is highly unlikely that B12 deficiency occurs solely in connection with an inadequate diet, patients with HIV infection are predisposed to malabsorption, which seems to be caused by a variety of infections and other disorders that affect the small intestine. An imbalance of vitamin B12 is documented in almost one in three AIDS patients, clearly demonstrating defective absorption of the vitamin. The diagnosis of B12 deficiency is made on the basis of a recorded low level of serum vitamin B12, while an early sign of a negative B12 balance is the detection of a low level of B12 in the blood of patients receiving transcobalamin II. Monthly administration of parenteral B12 should correct the deficiency, and absolutely anemia and pancytopenia in the peripheral blood. The consequence of B12 deficiency may be neurological dysfunctions (subacute combined degeneration of the cord) with motor, sensory and higher cortical dysfunctions. Possible B12 deficiency is often considered to be the cause of these neurological syndromes in HIV-infected individuals.

Causes and prevalence of anemia in HIV-infected women.

Levine and colleagues reported the prevalence and ratio of anemia in a group of 2056 HIV-infected women who were on a study at the National Institutes of Health (sponsored Women's Interagency HIV Study (WIHS)), sponsored by an interagency study of women's AIDS, compared with 569 HIV -negative women.Anemia was defined as a decrease in hemoglobin below 120 g/l.It was detected in 37% of HIV-infected women, versus 17% in HIV-negative women.The factors associated with anemia in both groups were African American race and MCV<80fl. Среди ВИЧ-инфицированных женщин анемия встречалась статистически чаще при уровне CD4+клеток менее 200 в 1мм3, высоким плазматическим уровнем РНК вируса, с клиническими проявлениями СПИДа, а также среди тех, кто принимал зидовудин.

Consequences of anemia in HIV-infected people. Survival.

More than 32,000 case histories were reviewed by the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project to identify the consequences of anemia in HIV-infected patients. In this study, anemia was taken as a decrease in hemoglobin below 100 g/l or clinical manifestations of anemia. Importantly, in this group, anemia was associated with an increased risk of death. Thus, the relative risk of death in patients with anemia who started the study with a CD4+ cell count >200 in mm3 was 148% higher than in patients with the same CD4 cell count who started without anemia, while the risk of death increased by 58%. those who started the examination with a CD4+ cell level below 200/mm3 and severe anemia. Interestingly, the risk of death is reduced in those patients who, for whatever reason, regained red blood, while the risk of death remains high (170%) in those who did not recover from anemia. A similar relationship between anemia and increased risk of death was also noted by Moore and colleagues. This study, including 2348 patients, was conducted at a large urban HIV clinic in Baltimore, Maryland. The development of anemia was associated with reduced survival, regardless of other prognostic factors. Importantly, the use of erythropoietin was associated with a reduced risk of death, as was the use of antiretroviral therapy. An additional study performed by EuroSIDA among 6725 HIV-infected patients found that severe anemia (Hb<80г/л) является веским независимым прогностическим фактором смертности, регулируемый уровнем CD4+клеток и ВИЧ-1 РНК уровень в плазме. В большом WIHS исследовании 2056 ВИЧ-инфицированных женщин, анемия была расценена как самостоятельный маркер укорочения выживаемости. Все исследователи пришли к единому мнению о клинической значимости анемии на ВИЧ-инфекции. Итак четыре крупных исследования выявили, что анемия является самостоятельным фактором риска, приводящем к укорочению жизни у ВИЧ- инфицированных пациентов.љ

Consequences of anemia in HIV-infected people. Disease progression.

In an attempt to develop a predictive system for HIV-infected patients on HAART, Lingren and colleagues at EuroSIDA evaluated 2027 patients initiating HAART from a baseline of 8457 subjects. The data were substantiated in two additional groups - 1946 and 1442 people, respectively. A total of 9.9% of subjects experienced clinical progression (either a new AIDS-defining illness or death), representing an incidence of 3.9 per 100 person-years. According to the results of a multidisciplinary study, 4 independent factors of disease progression were recognized: CD4+ cell count, HIV-1 load, AIDS clinic before HAART, and hemoglobin level. So non-severe anemia (Hb80-140 g/l in men and 80-120 g/l in women) is associated with a risk of disease progression or death of 2.2 (95% CI1.6-2.9, P<0001), тогда как выраженная анемия (НЬ<80г/л) связана с риском в 7,1 (95%CI 2.5-20.1, Р=0002).

Relationship between anemia and HAART

Recent studies have shown that HAART helps correct or eliminate anemia. In a study of 6725 HIV-infected patients in Europe, Mocroft and colleagues found that HAART was statistically associated with correcting hemoglobin levels. When used for a long time, HAART is likely to correct anemia. Thus, 65% of the study group were anemic before starting HAART, 53% of the anemia persisted for 6 months of HAART use, and 46% of those receiving this therapy for 12 months. In a study of 905 HIV-infected patients conducted by Johns Hopkins Medical Center in Baltimore, the use of HAART also demonstrated a reduction in anemia. Normal hemoglobin levels were observed in 42% of patients treated with HAART and in 31% of patients without HAART. A multivariate study of the use of HAART showed a clear relationship with the release of anemia, subject to the regulation of the level of CD4 + cells, HIV-1 viral load, taking into account gender, race, drugs used and the use of antianemic therapy. A large WHIS study of HIV-infected women on HAART for at least 6 months found a trend towards resolution of anemia, and longer HAART was associated with greater improvement.

The use of HAART is also associated with the prevention of anemia, but long-term use (more than 18 months) is necessary. Interestingly, HAART may also be associated with early prevention of anemia.

The mechanism of antianemic and preventive action of HAART is not completely clear. However, there is strong evidence that a reduction in viral load results in improved growth of common hematopoietic progenitors, decreased levels of HIV-1 in bone marrow stromal cells, and improved erythropoietin tolerance. In addition, Isgro and colleagues have shown that HAART is associated with increased growth of hematopoietic progenitor cells. Moreover, ritonavir, as a protease inhibitor, is associated with a reduction in apoptosis of hematopoietic progenitor cells and stimulates the growth of these cells in vitro.

Brief evolution of anemia in HIV-infected patients.

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In half of the observed cases, anemia was hypochromic and microcytic. In tuberculosis, hyperchromia and macrocytosis of erythrocytes did not occur at all. All patients had hypoplastic anemia.

Indicators of iron metabolism in HIV-infected patients with anemia

With the development of anemia, regardless of its etiology, there is a violation of iron metabolism. These indicators were studied in 50 patients from a group of 107 patients with HIV infection and anemia.

To carry out differential diagnosis of the two most significant types of anemia in patients with HIV infection - IDA and ACD, as well as to take into account a possible combined course, we used the algorithm proposed by Stepanova E.Yu. (modified algorithm by Guenter Weiss, 2005).

Figure 3. Algorithm for the differential diagnosis of ACD, IDA, and a combined variant of the course

Figure 3 shows that in 29 patients (58% of the study group) CST was less than 0.2. In 7 patients, a low level of ferritin (less than 30 ng/ml) was revealed. These patients were diagnosed with iron deficiency anemia: all of them had microcytosis and hypochromia characteristic of IDA.

In cases with a ferritin level of more than 30 ng/ml, the ratio of PPT to the decimal logarithm of ferritin was determined. A ratio of less than 1.5 was found in 16 patients, more than 1.5, respectively, in six.

In accordance with this algorithm, patients were divided into subgroups as follows: patients with IDA - 7 people (24.1%), with ACD - 16 (55.2%); 6 patients (20.7%) developed a mixed variant of anemia (IDA+ACD).

Anemia of chronic disease was the most common type of anemia, regardless of gender. It is also relevant for patients with varying degrees of anemia severity; while the most severe forms develop with concomitant iron deficiency.

It has been established that among patients with various opportunistic diseases, ACD is diagnosed much more often than IDA. With PVI 60.0%, with CMVI - 50.0%, with tuberculosis 71.4%, with candidiasis 66.7%, with hairy leukoplakia 100%.

conclusions

1. The average time (median) for the development of anemia in the stage of secondary diseases is significantly shorter than in the general population of HIV-infected patients and is 517 days. After 6 months, anemia develops in 32.8% of patients, after a year - in 46.1%, and after 2 - in 55.4%. The probability of its development is higher in women (p=0.043), it does not depend on the route of infection and the age of patients. The addition of secondary diseases in patients with immunodeficiency increases the likelihood of developing anemia (p = 0.03) by two times (median is 300 days).
2. The presence of complaints characteristic of anemia is of high value in its diagnosis: this clinical situation occurs 1.8 times more often than in the comparison group (p<0,05). Чувствительность теста «наличие клинических симптомов» в изучаемой группе составила 84,1%, что указывает на то, что анемия в этой стадии ВИЧ-инфекции формирует клинически манифестные варианты болезни.
3. In HIV-infected patients with laboratory signs of functional iron deficiency, the dominant variant of anemia is anemia of chronic disease, which was registered by us in 55.2% of patients. 24.1% of patients were diagnosed with iron deficiency anemia, and 20.7% - a combined variant of anemia of chronic disease and iron deficiency anemia.
4. The effect of opportunistic infections on hematopoietic processes is relatively small compared to direct exposure to HIV and is rarely the cause of severe anemia. Immunosuppression is the main factor influencing the severity of anemia (r=0.20; p=0.038).
5. Parvovirus infection is a common occurrence in HIV infection, recorded in almost every fifth patient with anemia (21%). However, anemia in this case does not have laboratory signs specific for this infection.
6. The positive effect of ART is associated with resolution of anemia. Anemia stops in the first year of treatment in 48.3% of patients, and after 2 years in 59.8%. The "antianemic" efficacy of the drugs is associated with the suppression of HIV replication. In 76.2% of patients, the viral load was completely suppressed at the time of anemia correction.

Introduce examination of patients for parvovirus infection into the standards of laboratory examination of HIV-infected people in the Republic of Tatarstan.

The development of clinical and laboratory signs of immunodeficiency in patients with HIV infection requires examination to detect anemia. The examination complex should include an assessment of iron metabolism indicators (serum iron, TIBC, ferritin, transferrin saturation coefficient, soluble transferrin receptors, erythropoietin)

Given the dominance of ACD in the structure of anemia in HIV-infected patients at the stage of secondary diseases, it is advisable to timely prescribe ARVT, which improves the indicators of "red blood" in this category of patients. The appointment of iron preparations is necessary when the level of CST is less than 0.20 and the level of ferritin is lower than 30 ng/ml.

1. Weight and height indicators of children with perinatal contact for HIV infection / G.R. Khasanova, A.A. Abrosimova, E.Yu. Stepanova, O.M. Romanenko // Pediatrics and pediatric surgery in the Volga Federal District: Proceedings of the III regional scientific and practical. conf. // Kazan Medical Journal. - 2006. - T. 87, application. - S. 89.
2. Anemia in children born to HIV-infected women / G.R. Khasanova, A.A. Abrosimova, E.Yu. Stepanova, O.M. Romanenko // Pediatrics and pediatric surgery in the Volga Federal District: Proceedings of the III regional scientific and practical. conf. // Kazan Medical Journal. - 2006. - T. 87, application. – S. 92.
3. Abrosimova A.A. Anemia in HIV-infected children / A.A. Abrosimova, G.R. Khasanova, M.V. Makarova // Topical issues of infectious pathology. Kazan. - 2007. - P.39.
4. Abrosimova A.A. A case of death from pneumocystis pneumonia in HIV infection /Abrosimova A.A., L.M. Malysheva, G.R. Khasanova // Young scientists in medicine: Proceedings of the XII All-Russian Scientific and Practical Conference. - Kazan: Fatherland, 2007.- P. 78.
5. The use of short interfering RNAs to reduce the expression of cellular proteins required for HIV 1 replication / E.V. Golovin, V.A. Anokhin, A.A. Rizvanov, A.A. Abrosimova, E.A. Martynova // Pediatrics and pediatric surgery in the Volga Federal District: Proceedings of the V regional scientific and practical. conf. // "Practical medicine" - 2008. - No. 6 (30) application. – S. 36.
6. Anemia and HIV infection / G.R. Khasanova, E.Yu. Stepanova, V.A. Anokhin,
   A.A. Abrosimova // Infectious diseases. - 2009. - T. 7. - No. 3. - S. 58-61.
7. Parvovirus infection / A.A. Abrosimova, V.A. Anokhin, G.R. Khasanova, E.Yu. Stepanova // Infectious diseases. - 2010. - T. 8. - No. 1. - S. 73-76.
8. Abrosimova A.A. Parvovirus B19 infection in HIV-infected patients with anemia / A.A. Abrosimova // Young scientists in medicine: Proceedings of the XV All-Russian Scientific and Practical Conference. – Kazan: Fatherland, 2010.- P. 85.
9. Abrosimova A.A. The role of parvovirus infection in the development of anemia in HIV-infected patients / A.A. Abrosimova, G.R. Khasanova, V.A. Anokhin // Proceedings of the III Annual All-Russian Congress on Infectious Diseases. - Moscow. - 2011. - P.-6.
10. Effect of antiretroviral therapy on hemoglobin levels in HIV-infected patients / A.A. Abrosimova, G.R. Khasanova, V.A. Anokhin, N.I. Galiullin // Interregional scientific-practical conference “Infectious diseases of adults and children. Topical issues of diagnosis, treatment and prevention. - Kazan. - 2011.- S.- 43.
11. Evaluation of the likelihood of anemia in patients with HIV infection using the Kaplan-Meier method / G.R. Khasanova, V.A. Anokhin, A.A. Abrosimova, F.I. Nagimova // Modern technologies in medicine. - 2011 - T. 4. - S. 109-112.

List of abbreviations

ART	antiretroviral therapy
AHZ	anemia of chronic disease
HAART	highly active antiretroviral therapy
HIV	AIDS virus
VLYA	hairy leukoplakia of the tongue
VEB	Epstein-Barr virus
IDA	Iron-deficiency anemia
ELISA	linked immunosorbent assay
CST	transferrin saturation factor
OHSS	total iron-binding capacity of serum
PVI	parvovirus infection
PPT	soluble transferrin receptors
RCPB AIDS and MOH RT	Republican Center for the Prevention and Control of AIDS and Infectious Diseases of the Ministry of Health of the Republic of Tatarstan
SJ	serum iron
AIDS	acquired immunodeficiency syndrome
CMVI	cytomegalovirus infection
AZT	zidovudine
d4T	stavudine
Hb	hemoglobin
MCH	average hemoglobin content in an erythrocyte
MCHC	average concentration of hemoglobin per unit volume
MCV	mean erythrocyte volume

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