Side effects of HAART

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DATE : Wed, 13 Dec 2006 14:54:00 -0600
Entered in Database : 2006-12-13 20:54:00
length : 2009938
Link to the Show / Show Notes

Welcome to this installment of the AIDS Pandemic, a podcast hosted by Dave Wessner of the Department of Biology at Davidson College. I am Justin Fried.

A study recently published in the Journal of Infectious Diseases credited AIDS treatment for saving 3,000,000 years of life in the United States (Walensky et al 2006). While effective treatment of common AIDS-related opportunistic infections has indeed benefited AIDS patients, the study cites treatments that decrease the virulence of the HIV virus as having the greatest impact on mortality rates of AIDS patients (Walensky et al. 2006). In the United States and countries that can afford it, the standard treatment for HIV is highly active antiretroviral treatment, HAART for short. HAART is composed of a combination of three or four drugs that fit into as many as three categories: reverse transcriptase inhibitors, protease inhibitors, and fusion inhibitors. Each of these categories of drugs attempts to interrupt the viral life cycle at a different point. Reverse transcriptase inhibitors block the activity of reverse transcriptase, an enzyme the virus uses to build new DNA from its RNA. Protease inhibitors inhibit the activity of viral enzymes used by HIV to cleave new proteins forfinal assembly into new HIV virons. Fusion inhibitors, the newest addition to the HAART treatment, block entry of HIV into the cell membrane, preventing infection of uninfected cells. The medications of HAART complement each other and are taken together to give an additive effect.

While the HAART treatment has had a profound impact on the AIDS epidemic in America, it should be understood that the HAART treatment is not a cure for HIV and carries its own drawbacks. Until recently, the only HAART treatments available were complicated regimens that required patients to take a series of pills at varying times of the day. Atripla, a new once a day HAART treatment, has greatly simplified the HIV treatment regimen but it is not for everyone. Aside from its expense, it is likely that the HIV virus in some people will eventually evolve to become resistant to one or more drugs in Atripla, and those patients will have to revert to more complicated treatment regimens.

While side effects of HAART treatment vary considerably between individuals and the particular medicines making up their therapy, the most common side effects include diarrhea, nausea, and vomiting ("Side effects"). Lipodystrophy is another common side effect of HAART treatment in which fat is redistributed to other parts of the body (Ammassari 2001). Often in this condition, face and limbs become thin while one's breasts, stomach and/or neck enlarge. Hyperglycemia and onset of diabetes have also occurred in a significant number of HAART patients. Liver toxicity including liver failure, pancreatitis and neuropathy are other unpleasant and potentially life threatening side effects experienced by some patients. These side effects can amount to such a physical and psychological burden that patients skip doses or stop taking their medications all together which increases the likelihood of drug resistance developing. In fact, about 25 % of patients stop therapy within the first year on HAART because of side effects (d'Arminio Monforte 2000). Reconstitution of the immune system, a major goal of HAART treatment, may even carry risks in some patients. A debilitating inflammatory syndrome has recently been linked to HAART treatment (Stoll and Reinhold 2004).

This podcast installation was not meant to scare anyone away from seeking HAART therapy; indeed as I stated earlier, it is very effective in combating infection and allows many HIV positive patients to live longer healthier lives. My goal was to simply alert people to the fact that there are frequently side effects and complications associated with HAART treatment. Prevention is still the best treatment for HIV that carries no side effects.

Until next time this is Justin Fried....

References:
Ammassari, A., Murri, R., Pezzotti, P., Trotta, M., Ravasio, L., De Longis, P., Caputo, S. Narciso, P., Pauluzzi, S., Carosi, G., Nappa, S., Piano, P., Izzo, C., Lichtner, M., Rezza, G., Monforte, A., Ippolito, G., Moroni, M., Wu, A., and A. Antinori. 2001. Journal of Acquired Immune Deficiency Syndromes, 28(5): 445-449.

d'Arminio Monforte, A., Lepri, A., Rezza, G. 2000. Insights into the reasons for discontinuation of the first highly active antiretroviral therapy (HAART) regimen in a cohort of antiretroviral naïve patients. AIDS, 14:499-507.

"Side Effects of HIV or Medication." The Body: The Complete HIV/AIDS Resourse. Retrieved October 12, 2006 from http://www.thebody.com/treat/side_effects.html.

Stoll, Mathias, and Reinhold Schmidt. 2004. Adverse events of desirable gain in immunocompetence: the Immune Restoration Inflammatory Syndromes. Autoimmunity Reviews, 3: 243-249.

"Side Effects of HIV or Medication." The Body: The Complete HIV/AIDS Resourse. Retrieved October 12, 2006 from http://www.thebody.com/treat/side_effects.html.

Walensky, R., Paltiel, A., Losina, E., Mercincavage, L., Schackman, B., Sax, P., Weinstein, M., and K. Freedberg. 2006. The survival benefits of AIDS Treatment in the United States. Journal of Infectious Diseases, 194: 11-19.