EPO and immune system disorder: The pathogenesis of HIV- related anemia is indistinct and is possible to be multifactorial in nature [1,30,31] Possible causes are bleeding (gastrointestinal malignancy/severe infection), insufficient dietary intake (vitamins such as cobalamin and folate, iron, and general malnutrition), haemolytic anaemia (i.e. malignancies, infections, splenomegaly, immune dysfunction), changes in erythropoietin synthesis and/or bone marrow suppression.