The Human Immunodeficiency Virus (HIV) is a retrovirus that causes progressive immunosuppression, making patients susceptible to various clinical conditions. Antiretroviral therapy used in patients with HIV/AIDS can induce several side effects, such as anemia; therefore, monitoring these effects is essential to prevent more serious complications.

To evaluate erythrocyte parameters in HIV-positive patients under ART in Caruaru, Pernambuco, between 2022 and 2023.

Cross-sectional, retrospective, analytical study including medical records of patients aged ≥ 18 years, on ART for more than one year, with undetectable viral load. The most recent complete blood count (2023) was analyzed, assessing age, sex, erythrogram parameters, and ART regimen. Data were tabulated in Excel and analyzed using descriptive statistics (means, standard deviations, medians) and inferential tests (Pearson’s chi-square and Fisher’s exact test) with a 5% error margin. Approved by the Asces-Unita Research Ethics Committee (approval no. 6.417.530).

Of 329 records, most patients were male (72.3%) and aged 40–59 years. The majority had been diagnosed within 1–5 years (59%). The most common ART regimen was tenofovir + lamivudine + dolutegravir (61.4%). Abnormalities were observed across all parameters, most frequently in MCHC (47.7%), MCH (28.6%), and MCV (16.4%). Significant associations were found between sex, duration of infection, and ART regimen, as well as between regimen type and alterations in red blood cell indices, MCV, and MCH.

Even patients with undetectable viral loads exhibited erythrocyte alterations, mainly in MCHC and MCH, influenced by sex and ART regimen. These findings reinforce the importance of continuous hematologic monitoring to enable early, individualized interventions for comprehensive care of people living with HIV.