https://www.inosr.

net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
©INOSR PUBLICATIONS
International Network Organization for Scientific Research ISSN: 2705-1706
https://doi.org/10.59298/INOSRSR/2023/1.2.12222

Understanding the Impact of HIV-Associated Bone Marrow Alterations on

Erythropoiesis

Emmanuel Ifeanyi Obeagu1, Getrude Uzoma Obeagu2, Esther Ugo Alum3,4

*

and Okechukwu Paul-Chima Ugwu4

1
Department of Medical Laboratory Science, Kampala International University, Uganda.
2
School of Nursing Science, Kampala International University, Uganda.
3
Department of Biochemistry, Ebonyi State, Abakaliki, Ebonyi State, Nigeria
4
Department of Publication and Extensions, Kampala International University, Uganda.

Corresponding author: Emmanuel Ifeanyi Obeagu, Department of Medical Laboratory

*

Science, Kampala International University, Uganda.

E-mail: emmanuelobeagu@yahoo.com, obeagu.emmanuel@kiu.ac.ug
ORCID: 0000-0002-4538-0161

ABSTRACT
Human Immunodeficiency Virus (HIV) infection presents a multifaceted challenge, extending
beyond its primary impact on the immune system to affect various organ systems. Among
these, the bone marrow, the primary site for hematopoiesis, undergoes substantial
alterations during HIV infection, profoundly influencing erythropoiesis—the process of red
blood cell production. Anemia, a prevalent hematologic complication in HIV-infected
individuals, often serves as a marker of disease progression and impacts overall health
outcomes. This paper aims to delve into the intricate relationship between HIV-associated
bone marrow alterations and their consequential effects on erythropoiesis. The mechanisms
underlying bone marrow changes in HIV infection, including direct viral effects,
dysregulation of cytokine networks, and inflammatory processes, significantly disrupt the
delicate balance necessary for efficient erythropoiesis. The impact of these alterations on
erythropoiesis manifests through ineffective red blood cell production, decreased
erythropoietin responsiveness, and shortened red blood cell lifespan. Chronic inflammation
further complicates erythropoietic processes, contributing to the development and
perpetuation of anemia in HIV-infected individuals. Therapeutic interventions encompass a
multifaceted approach, including antiretroviral therapy (ART) to control viral replication,
erythropoiesis-stimulating agents, and adjunctive nutritional support to manage anemia.
However, emerging research targeting bone marrow microenvironmental factors and novel
agents stimulating erythropoiesis offer promising avenues for future therapeutic
development.
Keywords: HIV, bone marrow, erythropoiesis, erythropoietin, antiretroviral therapy

INTRODUCTION
Human Immunodeficiency Virus (HIV) intricate relationship between HIV-
infection has emerged as a global health associated bone marrow alterations and
challenge, impacting millions of lives their consequential effects on
worldwide. Beyond its well-documented erythropoiesis, the process of red blood
effects on the immune system, HIV cell production, presents a complex yet
infection profoundly influences various crucial aspect of the disease's
organ systems, including the bone pathophysiology [1-10]. Hematologic
marrow, a vital hub for hematopoiesis. The complications, notably anemia, are

1
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
prevalent among individuals living with affected by HIV. This review endeavors to
HIV and often serve as significant comprehensively explore the mechanisms
indicators of disease progression and underpinning HIV-associated bone marrow
prognosis. The bone marrow, traditionally changes, elucidating their profound
recognized for its role in generating blood effects on erythropoiesis, and shedding
cells, undergoes a series of intricate light on therapeutic avenues and research
changes during HIV infection. These directions aimed at managing anemia in
alterations disrupt the finely orchestrated this context [22-32]. By examining the
hematopoietic process, specifically intricate dynamics within the bone marrow
affecting erythropoiesis, and contribute microenvironment during HIV infection
substantially to the development and and unraveling their repercussions on
perpetuation of anemia in this population erythropoietic processes, this review seeks
[11-21]. to contribute to the broader understanding
Understanding the nuanced interplay of hematologic complications in HIV and to
between HIV-induced bone marrow pave the way for targeted interventions
alterations and their subsequent impact on aimed at ameliorating anemia and
erythropoiesis is fundamental in enhancing the well-being of individuals
addressing anemia and improving the affected by this complex viral disease.
overall quality of life for individuals
HIV-Associated Bone Marrow Alterations
HIV infection is known to induce a the cellular composition of the bone
spectrum of alterations within the bone marrow and compromising its ability to
marrow, the primary site for support erythropoiesis [50-55].
hematopoiesis. These changes Opportunistic infections, commonly
significantly impact the bone marrow associated with HIV, can directly affect the
microenvironment, disrupting the bone marrow. These infections, such as
intricate balance necessary for efficient Mycobacterium avium complex and
hematopoietic function [33-36]. HIV cytomegalovirus, can cause bone marrow
exhibits a predilection for hematopoietic suppression, exacerbating the already
progenitor cells and bone marrow stromal compromised hematopoietic function seen
elements. Direct infection of these cells in HIV [56-61]. While ART is essential in
contributes to their dysfunction, affecting controlling viral replication and reducing
their ability to support normal the systemic impact of HIV, some
hematopoiesis. The virus alters the antiretroviral drugs have been associated
differentiation and proliferation of with hematologic side effects. Certain
hematopoietic stem cells, impeding their medications may directly or indirectly
capacity to generate mature blood cells affect bone marrow function, leading to
[37-43]. HIV infection triggers alterations in hematopoiesis [62-67].
dysregulated cytokine production and Overall, the cumulative effect of these
signaling within the bone marrow alterations within the bone marrow during
microenvironment. Elevated levels of pro- HIV infection results in a compromised
inflammatory cytokines such as TNF-α, IL- hematopoietic microenvironment. These
6, and IFN-γ disrupt the homeostasis changes disrupt the normal processes of
necessary for proper hematopoietic erythropoiesis and other blood cell
function. This dysregulation contributes production, contributing to the
to impaired hematopoiesis, including development of anemia and other
erythropoiesis [44-49]. Chronic hematologic complications commonly
inflammation induced by HIV infection has observed in individuals living with HIV.
a profound impact on the bone marrow. Understanding these bone marrow
Persistent immune activation and alterations is crucial for developing
inflammation adversely affect targeted therapeutic strategies to mitigate
hematopoietic stem cell function and their impact on hematopoiesis and
differentiation, leading to alterations in improve the overall health outcomes of
HIV-infected individuals.

2
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
Impact on Erythropoiesis
The impact of HIV-associated bone marrow infections can exacerbate anemia by
alterations on erythropoiesis, the process reducing the availability of essential
responsible for red blood cell production, nutrients required for red blood cell
is multifaceted and significantly production. Certain medications used in
contributes to the development of anemia HIV management, particularly
in individuals living with HIV [68-70]. HIV- chemotherapy for associated infections or
induced alterations in the bone marrow malignancies, can induce bone marrow
microenvironment led to ineffective suppression. This suppression directly
erythropoiesis. Disruption of affects erythropoiesis, leading to
hematopoietic stem cell function, decreased red blood cell production and
impaired differentiation, and decreased worsening anemia. The collective impact
production of erythroid progenitor cells of these factors on erythropoiesis results
contribute to a diminished capacity for in a state of chronic anemia commonly
efficient red blood cell generation [71]. HIV observed in individuals living with HIV.
infection, along with chronic inflammation Anemia, characterized by reduced red
and immune activation, can lead to blood cell count and hemoglobin levels,
increased destruction of red blood cells, contributes to fatigue, weakness, and
resulting in a shortened lifespan of these impaired quality of life. Understanding the
cells. This accelerated turnover intricate interplay between HIV-induced
contributes to a state of chronic anemia bone marrow alterations and their
[72]. Erythropoietin, a hormone crucial for consequences on erythropoiesis is crucial
regulating red blood cell production, may for developing targeted interventions
be affected by HIV-related alterations in aimed at ameliorating anemia and
the bone marrow. Some individuals with improving overall health outcomes in HIV-
HIV-associated anemia exhibit reduced infected individuals. Strategies focusing
responsiveness to erythropoietin, further on managing bone marrow dysfunction,
hindering the compensatory mechanism to optimizing erythropoietin responses,
increase red blood cell production [73-86]. addressing nutritional deficiencies, and
HIV infection and its associated minimizing medication-induced bone
complications often lead to nutritional marrow suppression are integral
deficiencies and comorbid conditions that components in the holistic management of
impact erythropoiesis. Malnutrition, anemia in the context of HIV.
gastrointestinal disturbances, and chronic
Implications for Health Policy Makers
Understanding the intricate relationship hematologic complications such as anemia
between HIV-associated bone marrow within the same framework can enhance
alterations and their impact on patient outcomes.
erythropoiesis holds significant Access to Antiretroviral Therapy (ART):
implications for health policy makers in Ensuring universal access to timely and
devising effective strategies to address continuous ART is pivotal. Health policies
anemia and improve the overall health should prioritize initiatives that facilitate
outcomes of individuals living with HIV. early HIV diagnosis, promote adherence to
Several key considerations can guide treatment, and expand access to
health policy formulation and antiretroviral medications. Viral
implementation: suppression through ART not only
Integrated Care Approach: Health policies mitigates bone marrow alterations caused
should advocate for an integrated care by uncontrolled viral replication but also
approach that acknowledges the indirectly improves erythropoiesis and
multifaceted nature of HIV-related reduces the burden of anemia.
complications, including anemia Screening and Management Protocols for
stemming from bone marrow alterations. Anemia: Health policy guidelines should
Comprehensive healthcare models that incorporate standardized screening
address both HIV management and protocols for anemia in HIV-infected

3
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
individuals, enabling early identification
and management of this prevalent
complication. Access to diagnostic tools
and interventions, such as erythropoiesis-
stimulating agents and iron
supplementation, should be ensured to
effectively manage anemia.
Nutritional Support Programs: Policies
promoting nutritional support programs
tailored for individuals living with HIV can
address malnutrition, a contributing factor
to anemia. Ensuring access to adequate
nutrition and addressing nutritional
deficiencies through targeted
interventions can positively impact
erythropoiesis and overall health
outcomes.
Research and Development Funding:
Health policies should allocate resources
CONCLUSION
In conclusion, the intricate relationship
between HIV-associated bone marrow
alterations and their profound impact on
erythropoiesis presents a crucial area of
consideration in managing hematologic
complications, particularly anemia, in
individuals living with HIV. The
complexities arising from bone marrow
dysfunctions during HIV infection
significantly contribute to the
development and perpetuation of anemia,
adversely affecting the quality of life and
overall health outcomes of affected
individuals. Therapeutic strategies
centered on viral suppression through
widespread access to antiretroviral
therapy (ART) constitute a cornerstone in
mitigating bone marrow alterations caused
by uncontrolled HIV replication.
REFERENCES
1. Chinedu K, Takim AE, Obeagu EI,
Chinazor UD, Eloghosa O, Ojong OE,
Odunze U. HIV and TB co-infection
among patients who used Directly
Observed Treatment Short-course
centres in Yenagoa, Nigeria. IOSR J
Pharm Biol Sci. 2017;12(4):70-5.
2. Offie DC, Obeagu EI, Akueshi C,
Njab JE, Ekanem EE, Dike PN, Oguh
DN. Facilitators and barriers to
retention in HIV care among HIV
infected MSM attending Community
Health Center Yaba, Lagos Nigeria.
for research initiatives focused on
understanding the mechanisms underlying
bone marrow alterations in HIV and their
specific impacts on erythropoiesis.
Funding support for studies investigating
novel therapeutic interventions targeting
bone marrow dysfunction and anemia in
HIV-infected populations is crucial.
Training and Education for Healthcare
Providers: Policies should emphasize the
importance of continuous training and
education for healthcare providers to
enhance their awareness and competence
in managing hematologic complications,
including anemia, in individuals living
with HIV. This includes staying updated on
evolving treatment strategies and best
practices.
Additionally, optimizing erythropoietin
responses, managing nutritional
deficiencies, and implementing screening
protocols for timely diagnosis and
management of anemia are crucial
components in holistic patient care. Health
policy makers play a pivotal role in
shaping initiatives that foster integrated
care models, ensure universal access to
ART, advocate for standardized screening
protocols, support nutritional
interventions, allocate resources for
research endeavors, and promote ongoing
education for healthcare providers. These
policies serve as the foundation for a
comprehensive approach aimed at
managing anemia and improving overall
health outcomes in HIV-infected
populations.
Journal of Pharmaceutical Research
International. 2021;33(52B):10-9.
3. Nwovu AI, Ifeanyi OE, Uzoma OG,
Nwebonyi NS. Occurrence of Some
Blood Borne Viral Infection and
Adherence to Universal Precautions
among Laboratory Staff in Federal
Teaching Hospital Abakaliki Ebonyi
State. Arch Blood Transfus Disord.
2018;1(2).
4. Ifeanyi OE, Uzoma OG, Stella EI,
Chinedum OK, Abum SC. Vitamin D
and insulin resistance in HIV sero
positive individuals in Umudike.

4
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
Int. J. Curr. Res. Med. Sci.
2018;4(2):104-8.
5. Ifeanyi OE, Leticia OI, Nwosu D,
Chinedum OK. A Review on blood
borne viral infections: universal
precautions. Int. J. Adv. Res. Biol.
Sci. 2018;5(6):60-6.
6. Obeagu EI, Obarezi TN, Omeh YN,
Okoro NK, Eze OB. Assessment of
some haematological and
biochemical parametrs in HIV
patients before receiving treatment
in Aba, Abia State, Nigeria. Res J
Pharma Biol Chem Sci. 2014; 5:825-
30.
7. Obeagu EI, Obarezi TN, Ogbuabor
BN, Anaebo QB, Eze GC. Pattern of
total white blood cell and
differential count values in HIV
positive patients receiving
treatment in Federal Teaching
Hospital Abakaliki, Ebonyi State,
Nigeria. International Journal of
Life Science, Biotechnology and
Pharama Research. 2014; 391:186-
9.
8. Obeagu EI. A Review of Challenges
and Coping Strategies Faced by
HIV/AIDS Discordant Couples.
Madonna University journal of
Medicine and Health Sciences ISSN:
2814-3035. 2023; 3 (1): 7-12.
9. Oloro OH, Obeagu EI. A Systematic
Review on Some Coagulation Profile
in HIV Infection. International
Journal of Innovative and Applied
Research. 2022;10(5):1-1.
10. Nwosu DC, Obeagu EI, Nkwuocha
BC, Nwanna CA, Nwanjo HU,
Amadike JN, Ezemma MC,
Okpomeshine EA, Ozims SJ, Agu
GC. Alterations in superoxide
dismutiase, vitamins C and E in HIV
infected children in Umuahia, Abia
state. International Journal of
Advanced Research in Biological
Sciences. 2015;2(11):268-71.
11. O'Brien ME, Kupka R, Msamanga GI,
Saathoff E, Hunter DJ, Fawzi WW.
Anemia is an independent predictor
of mortality and immunologic
progression of disease among
women with HIV in Tanzania. JAIDS
Journal of Acquired Immune
5
Deficiency Syndromes. 2005 Oct
1;40(2):219-25.
12. Obeagu EI, Malot S, Obeagu GU,
Ugwu OP. HIV resistance in patients
with Sickle Cell Anaemia. NEWPORT
INTERNATIONAL JOURNAL OF
SCIENTIFIC AND EXPERIMENTAL
SCIENCES (NIJSES). 2023;3(2):56-9.
13. Ifeanyi OE, Obeagu GU. The Values
of CD4 Count, among HIV Positive
Patients in FMC Owerri. Int. J. Curr.
Microbiol. App. Sci. 2015;4(4):906-
10.
https://www.academia.edu/downl
oad/38320134/Obeagu_Emmanuel
_Ifeanyi_and_Obeagu__Getrude_Uz
oma.EMMA2.pdf.
14. Obeagu EI, Okeke EI, Anonde
Andrew C. Evaluation of
haemoglobin and iron profile study
among persons living with HIV in
Umuahia, Abia state, Nigeria. Int. J.
Curr. Res. Biol. Med. 2016;1(2):1-5.
15. Alum EU, Ugwu OP, Obeagu EI, Okon
MB. Curtailing HIV/AIDS Spread:
Impact of Religious Leaders.
Newport International Journal of
Research in Medical Sciences
(NIJRMS). 2023;3(2):28-31.
16. Obeagu EI, Obeagu GU, Paul-Chima
UO. Stigma Associated With HIV.
AIDS: A Review. Newport
International Journal of Public
Health and Pharmacy (Nijpp).
2023;3(2):64-7.
17. Alum EU, Obeagu EI, Ugwu OP, Aja
PM, Okon MB. HIV Infection and
Cardiovascular diseases: The
obnoxious Duos. Newport
International Journal of Research in
Medical Sciences (NIJRMS).
2023;3(2):95-9.
18. Ibebuike JE, Nwokike GI, Nwosu DC,
Obeagu EI. A Retrospective Study
on Human Immune Deficiency
Virus among Pregnant Women
Attending Antenatal Clinic in Imo
State University Teaching Hospital.
International Journal of Medical
Science and Dental Research, 2018;
1 (2):08-14.
https://www.ijmsdr.org/published
%20paper/li1i2/A%20Retrospective
%20Study%20on%20Human%20Imm
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
une%20Deficiency%20Virus%20amo
ng%20Pregnant%20Women%20Atte
nding%20Antenatal%20Clinic%20in
%20Imo%20State%20University%20
Teaching%20Hospital.pdf.
19. Obeagu EI, Okwuanaso CB, Edoho
SH, Obeagu GU. Under-nutrition
among HIV-exposed Uninfected
Children: A Review of African
Perspective. Madonna University
journal of Medicine and Health
Sciences. 2022 ;2(3):120-7.
20. Obeagu EI, Alum EU, Obeagu GU.
Factors associated with prevalence
of HIV among youths: A review of
Africa perspective. Madonna
University journal of Medicine and
Health Sciences. 2023;3(1):13-8.
https://madonnauniversity.edu.ng
/journals/index.php/medicine/arti
cle/view/93.
21. Obeagu EI. A Review of Challenges
and Coping Strategies Faced by
HIV/AIDS Discordant Couples.
Madonna University journal of
Medicine and Health Sciences.
2023;3(1):7-12.
22. Obeagu EI, Obeagu GU. An update
on premalignant cervical lesions
and cervical cancer screening
services among HIV positive
women. J Pub Health Nutri. 2023; 6
(2). 2023;141:1-2.
links/63e538ed64252375639dd0df
/An-update-on-premalignant-
cervical-lesions-and-cervical-
cancer-screening-services-among-
HIV-positive-women.pdf.
23. Ezeoru VC, Enweani IB, Ochiabuto
O, Nwachukwu AC, Ogbonna US,
Obeagu EI. Prevalence of Malaria
with Anaemia and HIV status in
women of reproductive age in
Onitsha, Nigeria. Journal of
Pharmaceutical Research
International. 2021;33(4):10-9.
24. Omo-Emmanuel UK, Chinedum OK,
Obeagu EI. Evaluation of laboratory
logistics management information
system in HIV/AIDS comprehensive
health facilities in Bayelsa State,
Nigeria. Int J Curr Res Med Sci.
2017;3(1): 21-38.DOI:
10.22192/ijcrms.2017.03.01.004
6
25. Obeagu EI, Obeagu GU, Musiimenta
E, Bot YS, Hassan AO. Factors
contributing to low utilization of
HIV counseling and testing
services. Int. J. Curr. Res. Med. Sci.
2023;9(2): 1-5.DOI:
10.22192/ijcrms.2023.09.02.001
26. Obeagu EI, Obeagu GU. An update
on survival of people living with
HIV in Nigeria. J Pub Health Nutri.
2022; 5 (6). 2022;129.
links/645b4bfcf3512f1cc5885784/
An-update-on-survival-of-people-
living-with-HIV-in-Nigeria.pdf.
27. Offie DC, Obeagu EI, Akueshi C,
Njab JE, Ekanem EE, Dike PN, Oguh
DN. Facilitators and barriers to
retention in HIV care among HIV
infected MSM attending Community
Health Center Yaba, Lagos Nigeria.
Journal of Pharmaceutical Research
International. 2021;33(52B):10-9.
28. Obeagu EI, Ogbonna US,
Nwachukwu AC, Ochiabuto O,
Enweani IB, Ezeoru VC. Prevalence
of Malaria with Anaemia and HIV
status in women of reproductive
age in Onitsha, Nigeria. Journal of
Pharmaceutical Research
International. 2021;33(4):10-9.
29. Odo M, Ochei KC, Obeagu EI,
Barinaadaa A, Eteng UE, Ikpeme M,
Bassey JO, Paul AO. TB Infection
Control in TB/HIV Settings in Cross
River State, Nigeria: Policy Vs
Practice. Journal of Pharmaceutical
Research International.
2020;32(22):101-9.
30. Obeagu EI, Eze VU, Alaeboh EA,
Ochei KC. Determination of
haematocrit level and iron profile
study among persons living with
HIV in Umuahia, Abia State, Nigeria.
J BioInnovation. 2016;5:464-71.
links/592bb4990f7e9b9979a975cf
/DETERMINATION-OF-
HAEMATOCRIT-LEVEL-AND-IRON-
PROFILE-STUDY-AMONG-PERSONS-
LIVING-WITH-HIV-IN-UMUAHIA-
ABIA-STATE-NIGERIA.pdf.
31. Ifeanyi OE, Obeagu GU. The values
of prothrombin time among HIV
positive patients in FMC owerri.
International Journal of Current
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
Microbiology and Applied Sciences. MARKER-MDAAND-NON-
2015;4(4):911-6. ENZYMATIC-ANTIOXIDANTS-VIT-C-
https://www.academia.edu/downl E-IN-HIV-SEROPOSITIVE-CHILDREN-
oad/38320140/Obeagu_Emmanuel IN-AN-URBAN-COMMUNITY-OF-
_Ifeanyi_and_Obeagu__Getrude_Uz ABIA-STATE-NIGERIA.pdf.
oma2.EMMA1.pdf. 37. Nasiri K, Mohammadzadehsaliani S,
32. Izuchukwu IF, Ozims SJ, Agu GC, Kheradjoo H, Shabestari AM,
Obeagu EI, Onu I, Amah H, Nwosu Eshaghizadeh P, Pakmehr A,
DC, Nwanjo HU, Edward A, Arunsi Alsaffar MF, Al-Naqeeb BZ,
MO. Knowledge of preventive Yasamineh S, Gholizadeh O.
measures and management of Spotlight on the impact of viral
HIV/AIDS victims among parents in infections on Hematopoietic Stem
Umuna Orlu community of Imo Cells (HSCs) with a focus on COVID-
state Nigeria. Int. J. Adv. Res. Biol. 19 effects. Cell Communication and
Sci. 2016;3(10): 55-65.DOI; Signaling. 2023;21(1):1-5.
10.22192/ijarbs.2016.03.10.009 38. Igwe CM, Obeagu IE, Ogbuabor OA.
33. Pascutti MF, Erkelens MN, Nolte MA. Clinical characteristics of people
Impact of viral infections on living with HIV/AIDS on ART in
hematopoiesis: from beneficial to 2014 at tertiary health institutions
detrimental effects on bone marrow in Enugu, Nigeria. J Pub Health
output. Frontiers in immunology. Nutri. 2022; 5 (6). 2022;130.
2016; 7:364. links/645a166f5762c95ac3817d32
34. Chinedu K, Takim AE, Obeagu EI, /Clinical-characteristics-of-people-
Chinazor UD, Eloghosa O, Ojong OE, living-with-HIV-AIDS-on-ART-in-
Odunze U. HIV and TB co-infection 2014-at-tertiary-health-
among patients who used Directly institutions-in-Enugu.pdf.
Observed Treatment Short-course 39. Ifeanyi OE, Obeagu GU, Ijeoma FO,
centres in Yenagoa, Nigeria. IOSR J Chioma UI. The values of activated
Pharm Biol Sci. 2017;12(4):70-5. partial thromboplastin time (APTT)
links/5988ab6d0f7e9b6c8539f73d among HIV positive patients in FMC
/HIV-and-TB-co-infection-among- Owerri. Int J Curr Res Aca Rev.
patients-who-used-Directly- 2015; 3:139-44.
Observed-Treatment-Short-course- https://www.academia.edu/downl
centres-in-Yenagoa-Nigeria.pdf oad/38320159/Obeagu_Emmanuel
35. Oloro OH, Oke TO, Obeagu EI. _Ifeanyi3__et_al.IJCRAR.pdf.
Evaluation of Coagulation Profile 40. Obiomah CF, Obeagu EI, Ochei KC,
Patients with Pulmonary Swem CA, Amachukwu BO.
Tuberculosis and Human Hematological indices o HIV
Immunodeficiency Virus in Owo, seropositive subjects in Nnamdi
Ondo State, Nigeria. Madonna Azikiwe University teaching
University journal of Medicine and hospital (NAUTH), Nnewi. Ann Clin
Health Sciences. 2022;2(3):110-9. Lab Res. 2018;6(1):1-4.
36. Nwosu DC, Obeagu EI, Nkwocha BC, links/5aa2bb17a6fdccd544b7526e
Nwanna CA, Nwanjo HU, Amadike /Haematological-Indices-of-HIV-
JN, Elendu HN, Ofoedeme CN, Seropositive-Subjects-at-Nnamdi-
Ozims SJ, Nwankpa P. Change in Azikiwe.pdf
Lipid Peroxidation Marker (MDA) 41. Omo-Emmanuel UK, Ochei KC,
and Non enzymatic Antioxidants Osuala EO, Obeagu EI,
(VIT C & E) in HIV Seropositive Onwuasoanya UF. Impact of
Children in an Urban Community of prevention of mother to child
Abia State. Nigeria. J. Bio. Innov. transmission (PMTCT) of HIV on
2016;5(1):24-30. positivity rate in Kafanchan,
links/5ae735e9a6fdcc5b33eb8d6a/ Nigeria. Int. J. Curr. Res. Med. Sci.
CHANGE-IN-LIPID-PEROXIDATION-

7
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
2017;3(2): 28-34.DOI: 48. Jakheng SP, Obeagu EI.
10.22192/ijcrms.2017.03.02.005 Seroprevalence of human
42. Aizaz M, Abbas FA, Abbas A, immunodeficiency virus based on
Tabassum S, Obeagu EI. Alarming demographic and risk factors
rise in HIV cases in Pakistan: among pregnant women attending
Challenges and future clinics in Zaria Metropolis, Nigeria.
recommendations at hand. Health J Pub Health Nutri. 2022; 5 (8).
Science Reports. 2023;6(8): e1450. 2022;137.
43. Obeagu EI, Amekpor F, Scott GY. An links/6317a6b1acd814437f0ad268
update of human /Seroprevalence-of-human-
immunodeficiency virus infection: immunodeficiency-virus-based-on-
Bleeding disorders. J Pub Health demographic-and-risk-factors-
Nutri. 2023; 6 (1). 2023;139. among-pregnant-women-attending-
links/645b4a6c2edb8e5f094d9bd9 clinics-in-Zaria-Metropolis-
/An-update-of-human- Nigeria.pdf.
immunodeficiency-virus-infection- 49. Obeagu EI, Obeagu GU. A Review of
Bleeding.pdf. knowledge, attitudes and socio-
44. Camacho V, McClearn V, Patel S, demographic factors associated
Welner RS. Regulation of normal with non-adherence to
and leukemic stem cells through antiretroviral therapy among
cytokine signaling and the people living with HIV/AIDS. Int. J.
microenvironment. International Adv. Res. Biol. Sci. 2023;10(9):135-
journal of hematology. 2017; 42.DOI:
105:566-77. 10.22192/ijarbs.2023.10.09.015
45. Obeagu EI, Scott GY, Amekpor F, links/6516faa61e2386049de5e828
Ofodile AC, Edoho SH, Ahamefula C. /A-Review-of-knowledge-attitudes-
Prevention of New Cases of Human and-socio-demographic-factors-
Immunodeficiency Virus: Pragmatic associated-with-non-adherence-to-
Approaches of Saving Life in antiretroviral-therapy-among-
Developing Countries. Madonna people-living-with-HIV-AIDS.pdf
University journal of Medicine and 50. Lewis DE, Couturier JP. Chronic
Health Sciences. 2022 Dec Inflammation in HIV Pathogenesis:
20;2(3):128-34. Effects on Immune Cells, Organ
https://madonnauniversity.edu.ng Systems, and Systemic
/journals/index.php/medicine/arti Consequences. InTranslational
cle/view/86. Inflammation 2019: 111-131.
46. Walter O, Anaebo QB, Obeagu EI, Academic Press.
Okoroiwu IL. Evaluation of 51. Obeagu EI, Onuoha EC.
Activated Partial Thromboplastin Tuberculosis among HIV Patients: A
Time and Prothrombin Time in HIV review of Prevalence and
and TB Patients in Owerri Associated Factors. Int. J. Adv. Res.
Metropolis. Journal of Biol. Sci. 2023;10(9):128-34.DOI:
Pharmaceutical Research 10.22192/ijarbs.2023.10.09.014
International. 2022:29-34. links/6516f938b0df2f20a2f8b0e0/
47. Odo M, Ochei KC, Obeagu EI, Tuberculosis-among-HIV-Patients-
Barinaadaa A, Eteng EU, Ikpeme M, A-review-of-Prevalence-and-
Bassey JO, Paul AO. Cascade Associated-Factors.pdf.
variabilities in TB case finding 52. Obeagu EI, Ibeh NC, Nwobodo HA,
among people living with HIV and Ochei KC, Iwegbulam CP.
the use of IPT: assessment in three Haematological indices of malaria
levels of care in cross River State, patients coinfected with HIV in
Nigeria. Journal of Pharmaceutical Umuahia. Int. J. Curr. Res. Med. Sci.
Research International. 2017;3(5):100-4.DOI:
2020;32(24):9-18. 10.22192/ijcrms.2017.03.05.014

8
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
https://www.academia.edu/downl
oad/54317126/Haematological_ind
ices_of_malaria_patients_coinfecte
d_with_HIV.pdf
53. Jakheng SP, Obeagu EI, Abdullahi
IO, Jakheng EW, Chukwueze CM,
Eze GC, Essien UC, Madekwe CC,
Madekwe CC, Vidya S, Kumar S.
Distribution Rate of Chlamydial
Infection According to
Demographic Factors among
Pregnant Women Attending Clinics
in Zaria Metropolis, Kaduna State,
Nigeria. South Asian Journal of
Research in Microbiology.
2022;13(2):26-31.
54. Viola N, Kimono E, Nuruh N, Obeagu
EI. Factors Hindering Elimination of
Mother to Child Transmission of
HIV Service Uptake among HIV
Positive Women at Comboni
Hospital Kyamuhunga Bushenyi
District. Asian Journal of Dental
and Health Sciences. 2023 ;3(2):7-
14.
http://ajdhs.com/index.php/journ
al/article/view/39.
55. Okorie HM, Obeagu Emmanuel I,
Okpoli Henry CH, Chukwu Stella N.
Comparative study of enzyme
linked immunosorbent assay (Elisa)
and rapid test screening methods
on HIV, Hbsag, Hcv and Syphilis
among voluntary donors in. Owerri,
Nigeria. J Clin Commun Med.
2020;2(3):180-83.DOI: DOI:
10.32474/JCCM.2020.02.000137
links/5f344530458515b7291bd95f
/Comparative-Study-of-Enzyme-
Linked-Immunosorbent-Assay-
ElISA-and-Rapid-Test-Screening-
Methods-on-HIV-HBsAg-HCV-and-
Syphilis-among-Voluntary-Donors-
in-Owerri-Nigeria.pdf.
56. Tan IL, Smith BR, von Geldern G,
Mateen FJ, McArthur JC. HIV-
associated opportunistic infections
of the CNS. The Lancet Neurology.
2012;11(7):605-17.
57. Ezugwu UM, Onyenekwe CC, Ukibe
NR, Ahaneku JE, Onah CE, Obeagu
EI, Emeje PI, Awalu JC, Igbokwe GE.
Use of ATP, GTP, ADP and AMP as an
Index of Energy Utilization and
9
Storage in HIV Infected Individuals
at NAUTH, Nigeria: A Longitudinal,
Prospective, Case-Controlled Study.
Journal of Pharmaceutical Research
International. 2021;33(47A):78-84.
58. Emannuel G, Martin O, Peter OS,
Obeagu EI, Daniel K. Factors
Influencing Early Neonatal Adverse
Outcomes among Women with HIV
with Post Dated Pregnancies
Delivering at Kampala International
University Teaching Hospital,
Uganda. Asian Journal of Pregnancy
and Childbirth. 2023;6(1):203-11.
http://research.sdpublishers.net/i
d/eprint/2819/.
59. Igwe MC, Obeagu EI, Ogbuabor AO,
Eze GC, Ikpenwa JN, Eze-Steven PE.
Socio-Demographic Variables of
People Living with HIV/AIDS
Initiated on ART in 2014 at Tertiary
Health Institution in Enugu State.
Asian Journal of Research in
Infectious Diseases. 2022;10(4):1-7.
60. Vincent CC, Obeagu EI, Agu IS,
Ukeagu NC, Onyekachi-Chigbu AC.
Adherence to Antiretroviral
Therapy among HIV/AIDS in Federal
Medical Centre, Owerri. Journal of
Pharmaceutical Research
International. 2021;33(57A):360-8.
61. Igwe MC, Obeagu EI, Ogbuabor AO.
Analysis of the Factors and
Predictors of Adherence to
Healthcare of People Living with
HIV/AIDS in Tertiary Health
Institutions in Enugu State.
Madonna University journal of
Medicine and Health Sciences.
2022;2(3):42-57.
https://madonnauniversity.edu.ng
/journals/index.php/medicine/arti
cle/view/75.
62. Hima Bindu A, Naga Anusha P.
Adverse effects of highly active
anti-retroviral therapy (HAART). J
Antivir Antiretrovir. 2011;3(4):60-4.
63. Madekwe CC, Madekwe CC, Obeagu
EI. Inequality of monitoring in
Human Immunodeficiency Virus,
Tuberculosis and Malaria: A Review.
Madonna University journal of
Medicine and Health Sciences ISSN:
2814-3035. 2022;2(3):6-15.
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
https://madonnauniversity.edu.ng
/journals/index.php/medicine/arti
cle/view/69
64. Echendu GE, Vincent CC, Ibebuike J,
Asodike M, Naze N, Chinedu EP,
Ohale B, Obeagu EI. Weights Of
Infants Born to HIV Infected
Mothers: A Prospective Cohort
Study in Federal Medical Centre,
Owerri, Imo State. European Journal
of Pharmaceutical and Medical
Research, 2023; 10(8): 564-568
65. Nwosu DC, Nwanjo HU, Okolie NJ,
Ikeh K, Ajero CM, Dike J, Ojiegbe
GC, Oze GO, Obeagu EI, Nnatunanya
I, Azuonwu O. Biochemical
Alterations in Adult HIV Patients on
Antiretrqviral Therapy. World
Journal of Pharmacy and
Pharmaceutical Sciences, 2015;
4(3): 153-160.
links/5a4fd0500f7e9bbc10526b38
/BIOCHEMICAL-ALTERATIONS-IN-
ADULT-HIV-PATIENTS-ON-
ANTIRETRQVIRAL-THERAPY.pdf.
66. Obeagu EI, Obeagu GU. Effect of
CD4 Counts on Coagulation
Parameters among HIV Positive
Patients in Federal Medical Centre,
Owerri, Nigeria. Int. J. Curr. Res.
Biosci. Plant Biol. 2015;2(4):45-9.
67. Obeagu EI, Nwosu DC. Adverse drug
reactions in HIV/AIDS patients on
highly active antiretro viral
therapy: a review of prevalence. Int.
J. Curr. Res. Chem. Pharm. Sci.
2019;6(12):45-8.DOI:
10.22192/ijcrcps.2019.06.12.004
links/650aba1582f01628f0335795
/Adverse-drug-reactions-in-HIV-
AIDS-patients-on-highly-active-
antiretro-viral-therapy-a-review-of-
prevalence.pdf.
68. Herd CL, Mellet J, Mashingaidze T,
Durandt C, Pepper MS.
Consequences of HIV infection in
the bone marrow niche. Frontiers in
Immunology. 2023;14.
69. Obeagu EI, Scott GY, Amekpor F,
Obeagu GU. Implications of
CD4/CD8 ratios in Human
Immunodeficiency Virus infections.
Int. J. Curr. Res. Med. Sci.
2023;9(2):6-13.DOI:
10
10.22192/ijcrms.2023.09.02.002
links/645a4a462edb8e5f094ad37c
/Implications-of-CD4-CD8-ratios-
in-Human-Immunodeficiency-
Virus-infections.pdf.
70. Obeagu EI, Ochei KC, Okeke EI,
Anode AC. Assessment of the level
of haemoglobin and erythropoietin
in persons living with HIV in
Umuahia. Int. J. Curr. Res. Med. Sci.
2016;2(4):29-33.
links/5711c47508aeebe07c02496b
/Assessment-of-the-level-of-
haemoglobin-and-erythropoietin-
in-persons-living-with-HIV-in-
Umuahia.pdf
71. Wang X, Chen M, Ma S, Ding Y, Zhou
C, Yuan Y. HIV-1 Tat Protein-
Mediated Inflammatory Response
Inhibits the Erythroid
Hematopoietic Support Function of
Bone Marrow Mesenchymal Stem
Cells. AIDS Research and Human
Retroviruses. 2022;38(9):753-63.
72. Hunt PW. HIV and inflammation:
mechanisms and consequences.
Current HIV/AIDS Reports. 2012;
9:139-47.
73. Obeagu EI, Okoroiwu IL, Obeagu G.
Molecular mechanism and systemic
response of erythropoietin: A
Review. Int. J. Adv. Res. Biol. Sci.
2015;2(7):58-62.
74. Obeagu EI, Obeagu GU, Nchuma BO,
Amazue PO. A Review on
erythropoietin receptor (EpoR). Int.
J. Adv. Res. Biol. Sci. 2015;2(8):80-
4.
75. Obeagu EI. Erythropoeitin in Sickle
Cell Anaemia: A Review.
International Journal of Research
Studies in Medical and Health
Sciences. 2020;5(2):22-8.
76. Obeagu EI, Okoroiwu II, Ezimah AC.
Evaluation of serum erythropoietin
levels in chronic kidney disease
patients in Federal Medical centre,
Umuahia, Nigeria. Int. J. Curr. Res.
Biol. Med. 2016;1(4):15-21.
77. Ifeanyi OE. A review on
erythropoietin. Int J Adv Res Biol
Sci. 2015;2(4):35-47.
78. Obeagu EI, Ezimah AC, Obeagu GU.
Erythropoietin in the anaemias of
https://www.inosr.net/inosr-scientific-research/
Obeagu et al
INOSR Scientific Research 10(1):1-11, 2023.
pregnancy: a review. Int J Curr Res
Chem Pharm Sci. 2016;3(3):10-8.
79. Obeagu EI, Ochei KC, Okeke EI,
Anode AC. Assessment of the level
of haemoglobin and erythropoietin
in persons living with HIV in
Umuahia. Int. J. Curr. Res. Med. Sci.
2016;2(4):29-33.
80. Ifeanyi OE, Uzoma OG. A review on
erythropietin in pregnancy. J.
Gynecol. Womens Health.
2018;8(3):1-4.
81. Obeagu EI. Erythrocyte
enumeration and serum
erythropoietin in chronic kidney
disease patients: A study in Federal
Medical Centre, Umuahia, Nigeria.
International Journal of Advanced
Research in Biological Sciences.
2016;3(7):163-70.
82. Nnodim J, Uche U, Ifeoma U,
Chidozie N, Ifeanyi O, Oluchi AA.
Hepcidin and erythropoietin level
in sickle cell disease. British Journal
of Medicine and Medical Research.
2015 Jan 10;8(3):261-5.
83. Obeagu EI, Ezimah AC, Obeagu GU.
Erythropoietin in hypertension: A
review. J. Biol. Chem. Research.
2016;33(1):261-78.
84. Obeagu EI, Obeagu GU, Anaebo QB.
Studies on Serum Erythropoietin
and Red Cell Indices of Patients
with Urinary Tract Infection in
Southeast, Nigeria. Saudi Journal of
Biomedical Research.
2019;4(10):333-7.
85. Obeagu EI, Abdirahman BF, Bunu
UO, Obeagu GU. Obsterics
characteristics that effect the
newborn outcomes. Int. J. Adv. Res.
Biol. Sci. 2023;10(3):134-43.
86. Obeagu EI, Obeagu GU, Obiezu J,
Ezeonwumelu C, Ogunnaya FU,
Ngwoke AO, Emeka-Obi OR, Ugwu
OP. Hematologic Support in HIV
Patients: Blood Transfusion
Strategies and Immunological
Considerations. APPLIED SCIENCES
(NIJBAS). 2023;3(3).

CITE AS: Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu, Esther Ugo Alum and Okechukwu
Paul-Chima Ugwu (2023). Understanding the Impact of HIV-Associated Bone Marrow
Alterations on Erythropoiesis. INOSR Scientific Research 10(1):1-11.
https://doi.org/10.59298/INOSRSR/2023/1.2.12222

11