Erythropoietin (EPO) controls the growth, differentiation and life cycle of erythroid precursor cells. EPO is a erythropoiesis controller and medical treasure chest. Creating erythropoietin as a popular treatment for HIV-related anaemia. The drug is EPO, for HIV anaemia. Patients with HIV are anemic for different reasons: direct to the virus's attack on the hematopoietic system; drug side-effects; dehydration; and chronic inflammation.
Related Products
Physiological Role of Erythropoietin
Erythropoietin (EPO) is a glycoprotein hormone that makes sure there are plenty of red blood cells in the body, and also keeps the body's oxygen levels up. EPO regulates erythroid larval development, differentiation and growth. The hypoxic EPO produced, the more erythroid precursors that form and differentiate in bone marrow and the more erythrocytes and oxygen pumped into the bloodstream. Lost, EPO sticks to its own receptor, the erythropoietin receptor (EPOR), on the surface of bone marrow erythroid precursors. This association starts an intracellular signalling cascade that allows erythroid seedlings to grow, mature and differentiate.
Fig. 1 EPO regulates erythrocyte differentiation (Hong-Mou, S., et al. 2018).
Erythropoietin's Linchpin Role in HIV Anaemia
HIV-positive anaemia is all sorts of things — the mishmash of everything-with-everything relationships that tip the balance of erythropoiesis and haemoglobin production against each other. This complexity is the secret to developing individualised treatments to fight HIV anemia. Chronic inflammation, immune dysfunction, viral effects, opportunistic infection and side effects from antiretroviral (ART) drugs are the major cause of HIV anemia.
Improves Erythropoiesis
EPO acts directly by increasing the number and differentiation of erythroid precursor cells, creating more red blood cells and reducing anemia.
Reduces Fatigue
Anemia renders a patient fatigued and exhausted and EPO therapy will give the patient energy and wellbeing.
Combination Therapy
EPO may be added to other medications to achieve a higher efficacy in HIV patients on antiretroviral therapy (ART) to avoid adverse hematological effects from the drug.
Indications and Monitoring
In EPO treatment, doctors usually test the patient's iron, vitamin B12 folate, and other triggering factors.
HIV Effects on Erythropoietin Production
HIV is an ever-changing retrovirus, and its effects extend far beyond it to other bodily functions, such as erythropoiesis and the regulation of erythropoietin (EPO) . HIV may also affect the level of EPO directly, by interacting with cell types involved in erythropoiesis. HIV infection creates a chronic inflammatory condition in which proinflammatory cytokines are elevated. Such an inflammatory state can destabilize EPO production by rupturing normal regulatory channels. Interferon-, another player in the anti-HIV immune system, has also been shown to block EPO synthesis and make HIV infection patients more anemic. Amplification and dysfunction of erythropoiesis by HIV infection may occur. Violent immune systems can kill erythroid precursors, therefore reducing the number of cells that mature after EPO stimulation. The disease of HIV infection disrupts iron metabolism and can cause functional iron deficiency, even when normal iron reserves are in place. There is a need for sufficient iron to help EPO do its job in erythropoiesis. Imbalanced iron dynamics in HIV make anemia in this population more complex.
Conclusion
It's not just HIV and anemia – it's erythropoietin (EPO) and iron deficiency at play – which requires such sophisticated therapy. Anemia is still a major issue for people living with HIV. Erythropoietin has also become a promising secondary therapy to treat dysregulated erythropoiesis in HIV-related anemia. Learning how HIV interferes with EPO production could help to shed light on the pathophysiology of anemia, and to tailor interventions to restore normal erythropoiesis. And the fact that anemia with HIV can also cause iron deficiency complicates the treatment. Correct diagnosis, taking into account the effect of inflammation on standard iron markers, and intravenous iron supplementation are all part of the integrated therapy. Optimization of antiretroviral treatment and diets helps to make this integrated care possible for those living with the twin conditions of HIV and anemia.
References
- Obeagu, E.; et al. The Crucial Role of Erythropoietin in Managing Anemia in HIV: A Review. Elite Journal of Scientific Research and Review. 2024, 2(1): 24-36.
- Wu, Y., et al. Trial of erythropoietin for hypoxic–ischemic encephalopathy in newborns. New England journal of medicine. 2022, 387(2): 148-159.
- Hong-Mou, S., et al. Physiology and pathophysiology of renal erythropoietin-producing cells. Journal of the Formosan Medical Association. 2018, 117(11), 955-963.
.
