"I think blood transfusions have been prescribed far too freely," says Dr. Stephanie Seremetis, a specialist in blood products for PWAs at Mount Sinai School of Medicine in New York City. Yet these therapies are widely used to treat anemia, a common problem in people with advanced HIV infection, which causes fatigue, shortness of breath and dizziness.

A new study links blood transfusions in PWAs with increases in HIV viral load. This isn't surprising, since past studies have linked transfusions in people with HIV to increased risk of cytomegalovirus (CMV) infection (not generally screened from the blood supply), Mycobacterium avium complex (MAC), wasting and reduced survival time.

The new data pose a dilemma for PWAs facing anemia caused by such treatments as AZT. Bactrium, dapsone and ganciclovir, or by opportunistic infections such as MAC. Any of these, or HIV itself, can reduce hemoglobin--the protein in red blood cells that transports oxygen from the lungs to the tissues--to dangerously low levels.

Transfusions behave differently in each individual, often resulting in the transmission of other viruses such as Epstein-Barr and hepatitis. Seremetis advises the immune-compromised to think carefully before risking exposure to more pathogens.

Erythropoietin (EPO) is the drug approved by the FDA to treat anemia caused by AZT, chemotherapy or chronic kidney disease. But the drug can cause high blood pressure, is expensive, must be self-injected and can take six to eight weeks to work. (EPO is marketed as Procrit or Epogen. Procrit's manufacturer, Ortho Biotech, has a patient-assistance program to broaden the drug's availability.)

The best solution is closer monitoring of hemoglobin counts (listed on lab reports as Hb) to identify anemia before it becomes so serious that transfusion is the only option. A protein-rich diet and blood-cell-building nutrients such as vitamin B complex (particularly B-12 and folic acid), iron and zinc can also be helpful in preventing anemia.