Side effects of HIV treatment
Numerous anti-viral drugs, some in combined form, have been approved by the FDA for treatment of HIV to reduce the viral load and prevent destruction of the immune system. These drugs must be given in combination. However, they are all associated with side effects. The primary method of treating the side effects is to make a change in the antiviral medications. Major side effects may include the following:
o Hepatotoxicity
o Hyperglycemia
o Hyperlipidemia
o Lactic Acidosis
o Lipodystrophy
o Osteonecrosis, osteoporosis, osteopenia
o Skin rash
Hepatotoxicity
Damage to the liver is a side effect of all FDA-approved drugs in 3 classes:
o Nucleoside reverse transciptase inhibitors (NRTIs)
o Non-nuceloside reverse tgranscriptase inhibitors (NNRTIs
o Protease inhibitors (PIs)
Women, especially those who are pregnant; those with existing liver diseases, such as Hepatitis B or C; and those who use alcohol may be at higher risk for developing hepatotoxicity. There are a number of different conditions that can be related to hepatotoxicity caused by drug treatment, including the following:
o Hepatitis-inflammation of the liver (especially Viramune)
o Hepatic necrosis-death of liver cells (especially Viramune)
o Hepatic steatosis-too much fat in the liver, may be associated with lactic acidosis (especially Zerit, Videx, and Retrovir)
Signs and symptoms:
o Increase in liver enzyme levels in the blood
o Alanine aminotransferase (ALT)
o Aspartate aminotransferase (AST)
o Gamma-glutamyltransferase (GGT)
o Gastro-intestinal
o Nausea
o Vomiting
o Abdominal pain
o Loss of appetite
o Diarrhea
o Other
o Weakness, general malaise
o Jaundice
o Hepatomegaly
Rapid feedback:
Hepatotoxicity can include hepatitis, hepatic necrosis, or hepatic steatosis.
True.
Hyperglycemia/Diabetes
An increase in blood glucose levels by itself or as part of diabetes mellitus is a side effect of all protease inhibitors (PIs)), especially for those with hepatitis C virus. People who are older, overweight, have a family history of diabetes, and are from certain ethnic groups (such as African American) are at greater risk.
Signs and symptoms:
o Increase in serum glucose level
o Excessive thirst or hunger
o Increased urination
o Unexplained weight loss
Rapid feedback:
Hyperglycemia or diabetes is a side effect of protease inhibitors.
True
Hyperlipidemia
An increase in the lipids in the blood, such as cholesterol and triglycerides, is a side effect of some protease inhibitors (PIs). Older PIs, such as Norvir, are more commonly implicated than newer PIs, such as Reyataz. Sustive, a non-protease inhibitor drug can also raise blood lipid levels. Other risk facts include alcohol intake, lack of physical activity, diet high in fats, hypothyroidism, diabetes, and genetic factors. Oral contraceptives can also increase lipid levels. Hyperlipidemia can result in heart disease or pancreatitis.
Signs & symptoms:
o Increase in serum lipids found on lipid profile
o No other direct symptoms
Lactic acidosis (Hyperlactatemia)
Too much lactate in the blood and a low blood Ph (acidic) are side effects of mitochondrial toxicity caused by of all nucleoside reverse transcriptase inhibitors (NRTIs); however, Zerit and Videx seem to put people at greatest risk. Women and people who are overweight are at increased risk. Fatal lactic acidosis has occurred in pregnant women taking both Zerit and Videx. People with HIV and Hepatitis C taking Rebetol may also be at increased risk.
Lactic acid is a chemical that results from energy production in cells. Mitochondria, rod-like structures in the cells, help to convert food into energy. The food is broken down into glucose and mitochondria utilize oxygen to convert glucose to energy. If there is not enough oxygen or a defect in the functioning of the mitochondria, then cells make energy without oxygen, producing lactic acid as a byproduct. Lactic acid is converted into lactate in the blood. Lactate is formed when lactic acid loses a hydrogen atom, but this atom stays in the blood and decreases the Ph, making the blood more acidic. Lactate is broken down in the liver, but if too much is produced, the liver cannot keep up, or if the liver is damaged, it may not be functioning properly. NRTIs cause mitochondrial toxicity by blocking the function of polymerase-gamma, a protein that mitochondria need to work properly.
Signs & symptoms:
o Abnormal lab findings
o Liver function tests
o Electrolyte level
o Blood Ph level
o Lactate level (this test is difficult to do and is not routinely done)
o Gastrointestinal
o Persistent nausea
o Vomiting
o Abdominal pain
o Respiratory
o Dyspnea, shortness of breath
o Rapid breathing
o Circulatory
o Cold or cyanosis of hands and feet
o Arrhythmia
o Other
o Weight loss
o Enlarged or tender liver
Rapid feedback:
Too little lactate in the blood and high blood Ph are signs of lactic acidosis.
False
Lipodystrophy
Fat redistribution, a disturbance in the way the body produces, uses and stores fat, is a side effect of the concurrent use of nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs). Zerit tends to cause fat loss, and PIs to cause fat accumulation. There are numerous additional risk factors:
o Age-older people
o Race-whites
o Sex
o Males-more likely to lose fat in arms and legs
o Females-more likely to gain fat in abdomen and breasts
o Length and severity of infection
o Obesity or significant weight changes
o Base immune system health and recovery
There are two different types of lipodystrophy with differing symptoms:
o Lipoatrophy (fat wasting)
o Fat may be lost in a number of places
o Face, resulting in sunken cheeks, temples, and eyes
o Arms and legs, making veins more visible (called “roping”)
o Buttocks
o Hyperadiposity (fat accumulation)
o Fat may accumulate in a number of places
o Back of the neck and upper shoulders (“buffalo hump”)
o Abdomen (“protease paunch” or “Crixivan potbelly”)
o Breasts (both male and female)
o Lipomas (fatty growths in different parts of the body)
Rapid feedback:
Males are more likely to have lipoatrophy and females, hyperadiposity.
True
Osteonecrosis, osteopenia, and osteoporosis
Damage to the bones is a side effect of HIV and some of the damage is related to protease inhibitors (PIs). There are 3 different bone disorders related to HIV:
o Osteonecrosis-the blood supply to the bone is impaired, resulting in death of cells (avascular necrosis). Occurs in the hipbones of some people with HIV. Researchers are not clear if osteonecrosis is caused by HIV itself or by the medications used to treat HIV.
o Signs and symptoms
o Pain in affected area
o Limited range of motion, stiffness, limping
o Progressive bone damage leading to collapse
o Osteopenia-the bones lose minerals and become less dense.
o Signs and symptoms may be missing, but leads to osteoporosis
o Osteoporosis-advanced osteopenia that weakens the bones so that they may fracture. Most common fractures involve the spine, wrists or hips. Osteopenia and osteoporosis are side effects of protease inhibitors (PIs)
o Signs and symptoms
o Neck or low back pain
o Bone pain or tenderness
o Loss of height
o Stooped posture
o Additional risk factors for osteopenia/ osteoporosis include the following:
o Female
o Corticosteroid use or other medications
o Smoking
o Abuse of alcohol
o Low body weight
Rapid feedback:
People receiving protease inhibitors (PIs) should be observed for signs of osteopenia and osteoporosis.
True
Skin rash
Skin rash is a side effect of all FDA-approved drugs in 3 classes:
o Nucleoside reverse transciptase inhibitors (NRTIs)
o Non-nuceloside reverse tgranscriptase inhibitors (NNRTIs
o Protease inhibitors (PIs)
NNRTIs cause most skin rashes, with Viramune causing the most severe rashes. NRTIs can also cause skin rashes. Ziagen may cause a severe hypersensitivity allergic rash. People who develop a rash from Ziagen should never take Ziagen again as they might be in danger of a more severe allergic response. Agenerase, a PI, is also likely to cause skin rash. Severe skin rashes associated with HIV are Stevens-Johnson sydrome (SJS) and toxic epidermal necrolysis (TEN), two different forms of the same disorder. They differ in the amount of the body involved. SJS involves less than 30% of the body, but TEN involves 30% or more.
Symptoms include:
o Flat or raised red spots on the skin that develop blisters in the center
o Blisters in the mouth, eyes, genitals, or other moist areas
o Peeling skin resulting in painful sores
o Fever
o Headaches
o General malaise
Another rare but life-threatening rash is part of the DRESS syndrome (drug rash with eosinophilia and systemic symptoms).
Symptoms include:
o Rash
o Fever
o Blolod abnormalities
o Organ inflammation
Rapid feedback:
Protease inhibitors (PIs) cause most skin rashes.
False