Wednesday, December 13, 2006

Side effects of HAART

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 for final 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.

5 comments:

J.G. said...

I want to tell my story and do not have a good venue for it. It is truly bizarre. I was given the most powerful HAART medication topically for warts and I am not HIV positive. It is called Cidofovir. It was supposed to be a 2% strength. I later found out the pharmacy mixed it by weight. The drug, is a last resort anti-nucleotide drug to slow CMV in AIDS patients. I found out that the drug is supposed to be dosed a 5 mgs/kg. or about 300-500 mg. That amounts to about 3-5 drops of this medication. It comes in a vial of 5mls, containing 75mgs/ml. This drug only went through trials in very small amounts and applied with a q-tip. I put this on in 2003 over my entire genital area prophilactically 4 or 5 times. I found out later they mixed the gel with 3 and 1/4 vials of Cidofovir, a tremendous amount, as this drug is supposed to be diluted. What the drug actually did was completely damage me. I didn't know at the time. What happened was I went into a jacuzzi 2 weeks after applying the dosage of Cidofovir. My skin turned red, I went to a dermatologist, they gave me some powder, then it got, then creams, then my skin started coming off, and i was left with ulcers that would not heal. They were negative for yeast and bacteria. The scab would form and then melt off over night. This went on for weeks. I thought I was having a bad reaction to the other topicals. Infact it had affected my cells. During that time all kinds of other symptoms presented themselves, stomach problems, sensitivities to food, mold. All things that were not problems before had become crippling. I didn't quite understand what was going on. There were changes in my attitude, and I became reactive to almost everything. It seemed like I slowly got a little better when in-fact I made adjustments in my life. I had neuropathies, and many skin problems. I didn't identify it with this drug. I went back and got some more in February of 2006 because of another HPV exposure that was causing discomfort, not knowing it was the effect of the Vistide that source of my problems. Again, after application to the entire region, I lost skin, and this time had to go to a wound care specialist to repair the erosions. There was redness and irritation that was stuck in stasis for a month. It was unbelievable. There were uclers that were literally stuck in stasis. Seeing your skin not regenerate, and to be otherwise previously healthy, I knew this time it was from this drug. There were more serious sensitivities, anxiety around mold, foods, it is truly bizarre. Any medicine given to me produced severe reactions. My body no longer could handle foods properly. I couldn't use normal soaps or shampoos. I went to a special doctor to try to detoxify for the side effects. I was in severe nerve pain. It turns out I had severe vasculitis. Upon administration of oxygen, things got even worse. It literally sped up my system somehow and caused my diet to be more restrictive. It was like there was a rubber wall. The more oxygen my functions just got worse out of whack. I became hyper thirsty to the point that I was drinking 20 liters of water a day. Any medication prior to that, and we tried them all caused excessive drinking of water. My diet got down to just a few items. I could no longer handle anything acidic. It was a complete nightmare. I had a company with over a hundred people and was extremely functional, and I have not been able to go back to work and I don't know if I ever will. I have witness who have seen the most unbelievable things happen to me. I do not loose muscle mass, I lost and gained weight very quickly. Many foods were literally passing through my system undigested. A lot of them were soft foods, which is medically impossible. The doctors tried hyperbarric oxygen therapy. That was a big mistake. I have become so damaged the the skin where this was applied, my hands and face, literally become greasy with warm water, to the point where grease can be scraped from my pores. With a little soap my skin becomes so dry that I get exfoliative dermatitis. Any physical injuries result in extreme pain. Things never seem to heal, The cells themselves are completely over-reactive and this never resolves. It has almost a year and I live to survive. That is the beginning of the story. I can't go in the sun, the ocean, the heat, nothing too cold. It's a nightmare. I was fully functional before and literally went everywhere. I now have evidence of DNA breakdown in blood after saline administration, with Cytosine levels that are 4 times higher than the other elements. I also have a test show RNA auto-anti-bodies. I have another test showing increased cell synthesis and cell death. Now, my one doctor is checking me for cancer. Beyond hypospermia and kidney failure, cancer is another side effect of the drug. I will go a step further and tell you emphatically that Gilead is killing people with Cidofovir. This is wrong. People think that HAART drugs are saving lives. They may be, but they also may be taking lives. In my case, the hell that I have been in and the fact that I can no longer metabolize a medicine, or heal properly, makes me a medical anomoly. I don't have a venue to share this. There are no doctors who know what to do or how to fix this. I will tell you that I was exposed to 2 grams or more of this drug. 400 mgs. correctly by I.V. with 2 liters of saline and probenicid to protect the kidney. And this stuff was applied to my skin and just systemically damaged me. Metabolically, I am totally damaged. I don't synthesis things properly, I have nerve damage and vascular damge. After oxygen, vein damage, arterisclerosis. Hyper-reactivity of LDL, extremely low testosterone, high levels of IGE and I will never be the same. This doctor took my life because he was an idiot, administering a drug, he told me was an anti-viral gel with no side effects.

Evorgleb said...

I hope they come up with a real cure for this AIDS soon. I just did a blog over on Highbrid Nation about the African President giving his people a "cure" for AIDS if any of you care to read it. Its a sad situation that I hope ends soon.

Anonymous said...

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WAKE UP FOR GODSAKE...

Fiankok said...

HAART is relatively new in Africa. the parkage seem to have come with only the good news of its effectiveness in prolonging the life of people living with HIV/AIDS and a lot of instructions for taking the medication including regular blood tests.

Mr. Fried please get intouch and lets see how we can collaborate for a project am undertaking at the moment. fiankok@gmail.com

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