Cytopenias With HIV in the Era of Highly Active Antiretroviral Therapy: Are We Winning the Battle?

Background and Aim: Cytopenias remain among the most frequent hematologic complications of HIV infection, affecting treatment outcomes and quality of life. The introduction of highly active antiretroviral therapy has markedly reduced their incidence by restoring immune function and suppressing viral replication. However, the magnitude of this progress varies widely between developed and underdeveloped regions. While cytopenias have declined substantially in developed countries due to early HAART initiation and advanced monitoring, they remain prevalent in low-resource settings where delayed diagnosis, coinfections, and limited healthcare infrastructure persist. This review aims to synthesize current evidence on HIV-associated cytopenias in the HAART era, comparing regional trends, underlying mechanisms, and management outcomes. Methods: . Eligible peer-reviewed articles, reviews, and reports addressing the epidemiology, pathogenesis, and clinical management of cytopenias in adults living with HIV were included. Results: Evidence shows a substantial decline in the prevalence and severity of cytopenias in developed regions, largely due to early HAART initiation, improved monitoring, and access to less myelotoxic drug regimens. In contrast, in underdeveloped regions, cytopenias remain common, driven by delayed diagnosis, limited HAART coverage, malnutrition, coinfections, and inadequate laboratory capacity. Persistent anemia and thrombocytopenia continue to undermine quality of life and treatment outcomes in these settings. Conclusion: The global fight against HIV-associated cytopenias illustrates both the success and inequity of the HAART era. While developed countries have largely overcome the burden, underdeveloped regions continue to struggle with preventable hematologic complications. To fully "win the battle," there is an urgent need for equitable access to early diagnosis, optimized therapy, and comprehensive hematologic support worldwide.