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Toxicity to the bone marrow can cause the numbers of important blood cells to drop. A drop in the level of red blood cells can lead to a condition called anemia. Other blood cells that can be affected include bacteria-fighting white blood cells called neutrophils (a low level of these cells is called neutropenia). Less commonly, all blood cells can be affected and this condition is called pancytopenia.
Symptoms of anemia can be tiredness, shortness of breath and dizziness. Neutropenia can lead to an increased risk of bacterial infection.
zidovudine (AZT, Retrovir) is the most common cause of bone marrow toxicity. More rarely lamivudine (3TC, Epivir) has also been associated with neutropenia.
In zidovudine studies, the risk of developing anemia was related to the stage of HIV disease and the dose of Retrovir used. Out of the people with T-cell counts less than 200, around a third developed anemia. In people with higher T-cell counts, around 1-4% (1 in 100 to 1 in 25) developed anemia. The risk of developing neutropenia followed a similar pattern.
Bone marrow suppression is diagnosed by testing blood cell levels on your regular blood work.
The problem is usually treated by switching NRTI drugs. Most commonly, this involves changing from zidovudine to stavudine (d4T, Zerit). In severe cases, bone marrow stimulating drugs may also be used. The drug erythropoietin (Epogen, Procrit) can help increase production of red blood cells. The drug filgrastim (Neupogen) can help increase production of neutrophils. In the past, blood transfusions were sometimes used as a treatment for anemia. Recent studies have found that blood transfusions should be avoided in people with HIV if at all possible. This is because blood transfusions are associated with increases in HIV viral load and more rapid disease progression.
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