Epoetin alfa and beta

Epoetin alfa and beta are natural hormone-like substances found in the body that stimulate the bone marrow to produce red blood cells. They are mass-produced using recombinant genetic engineering techniques and used as an injectable treatment for anaemia.

Epoetin alfa and beta are also known as erythropoietin. The alfa and beta forms have exactly the same effects. In the United Kingdom epoetin alfa is marketed by Janssen-Cilag under the trade name Eprex and by Roche under the tradename NeoRecormon. In the United States, it is also known by the trade names Epogen and Procrit.

In people with HIV, epoetin alfa is used to alleviate the anaemia caused by AZT (zidovudine, Retrovir). It can also alleviate the anaemia resulting from hepatitis C treatment in HIV-co-infected patients.1 No significant side-effects have been seen in people with HIV.

A recent study showed that epoetin alfa can be dosed once weekly at 40,000U in patients with anaemia, and results in increases in haemoglobin (the key constituent of red blood cells) and improved quality of life.2 3 Another study has found that it may be dosed every two or three weeks once a person has achieved a haemoglobin level above 13g/dl.4 The standard alternative treatment for anaemia is blood transfusion, but one study has found that this was associated with increased risk of death in HIV patients with anaemia, even after adjusting for antiretroviral use, AIDS status, CD4 cell count, viral load and haemoglobin level. In contrast, epoetin alfa was not linked to an increased risk of death.5

Another synthetic form of erythropoietin, called recombinant human erythropoietin or r-HuEPO, has been successfully used to treat pregnant HIV-infected women.6 A test-tube study has also shown that epoetin alfa and beta may prevent neuropathy caused by HIV or nucleoside reverse transcriptase inhibitors (NRTIs).7

A related synthetic form of erythropoietin called darbepoetin alfa (Aranesp) can also be used to treat anaemia in HIV-positive patients. Although administered at a lower dose than epoetin alfa, the two drugs had similar efficacy and side-effects in a study of HIV-positive patients undergoing haemodialysis because of chronic kidney disease. However, darbepoetin alfa may be preferable as it is injected once a week and may be more cost-effective than epoetin alfa.8

References

  1. Sulkowski MS et al. Epoetin alfa once weekly improves anemia in HIV / hepatitis C virus-coinfected patients treated with interferon / ribavirin: a randomized controlled trial. J Acquir Immune Defic Syndr 39: 504-507, 2005
  2. Saag MS et al. Once-weekly epoetin alfa improves quality of life and increases haemoglobin in anemic HIV+ patients. AIDS Res Hum Retroviruses 20: 1037-1045, 2004
  3. Abrams DI et al. Epoetin alfa therapy for anaemia in HIV-infected patients: impact on quality of life. Int J STD AIDS 11: 659-665, 2000
  4. Levine AM et al. Evaluating apoetin alpha 40,000 U SC every 2 weeks to maintain hemoglobin levels in anemic, HIV-infected patients. Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, abstract H-1919, 2003
  5. Buskin SE et al. Association of treatments for anemia and survival among persons with HIV infection and anemia. Second International AIDS Society Conference, Paris, abstract 1154, 2003
  6. Troncoso AR et al. Experience with recombinant human erythropoietrin (r-HuEPO) and HIV anemia during pregnancy. Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, abstract H-1918, 2003
  7. Keswani SC et al. Erythropoietin is neuroprotective in models of HIV sensory neuropathy. Neurosci Lett 371: 102-105, 2004
  8. Lucas C et al. Effectiveness of weekly darbepoetin alfa in the treatment of anaemia of HIV-infected haemodialysis patients. Nephrol Dial Transplant (online edition), 2006

Up a level
Back to contents
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.