Treatment Review, Issue #29 * Winter 1999
Although these side effects can sound very scary, the important
point is that they can usually be avoided with proper care and
monitoring. If you need help finding a care provider that's
experienced in treating HIV, call The Network. The next issue
of Treatment Review will have a full update on the body shape
changes and face wasting (sometimes called lipodystrophy) that
are also side effects of HAART. Anti-HIV drugs can cause
serious side effects. Because HAART combinations include three
or more anti-HIV drugs, watching out for side effects is
becoming even more important. Laboratory testing (bloodwork) is
one of the methods used to monitor for potential side effects.
In addition to regular bloodwork, if you're taking HAART
combinations you should talk to your doctor about:
Triglycerides and cholesterol: These are types of fats found in
the blood. HAART combinations, especially combinations
including protease inhibitors, have been linked to increases in
these fat levels. Fat build up in blood vessels can cause heart
disease. Heart problems, including heart attacks, have been
reported in a few people taking HAART combinations in the
United States and United Kingdom. General recommendations about
cholesterol levels and heart disease say that a level of less
than 200 mg/dL is best, while 200 - 239 may be a little high.
Cholesterol levels of 240 or greater are associated with a high
risk of heart disease. The normal range for triglycerides is 40
- 150 mg/dL. HIV infection alone can sometimes cause
triglycerides to be higher than normal.
Blood sugar: High blood sugar is another potential side effect
of HAART. In some cases, high blood sugar has led to diabetes.
As with fat levels, this problem has most often been linked to
protease inhibitors. Blood sugar levels can be monitored to
look for any sign of this problem. Some doctors recommend using
a test called the glucose tolerance test (GTT), which also
looks for signs of diabetes.
Kidney function: Several anti-HIV drugs can potentially cause
kidney damage. If signs of kidney damage are not noticed
quickly enough, the kidneys can fail. Kidney failure is
life-threatening. The protease inhibitor Crixivan can cause
kidney stones. These aren't always normal kidney stones, but
solid lumps of Crixivan that have formed in the kidneys. Early
Crixivan studies found that about 1 in 20 (5%) of people taking
the drug got kidney stones. A recent study in women found that
about 1 in 4 (28%) developed signs of kidney problems after a
year. In a few cases, these kidney stones have led to kidney
failure. Kidney problems have also been reported with the
protease inhibitor ritonavir (Norvir). The experimental
anti-HIV drug adefovir (Preveon) can cause a type of kidney
damage called Fanconi-like syndrome. In some cases,
Preveon-related kidney damage has not improved despite stopping
the drug. Monitoring kidney function includes measuring
creatinine levels in the blood and regular testing of the urine
for signs of kidney problems.
Uric acid: Testing blood levels of uric acid can monitor for a
condition called hyperuricemia. This condition can also be a
sign of kidney problems. Symptoms of hyperuricemia are joint
pain and arthritis. Several studies have reported these
problems in people taking HAART.
Liver function: Liver problems are a common side effect of many
prescription drugs. The basic tests for measuring the health of
the liver are called liver enzyme tests. These are usually done
as a part of regular bloodwork. NRTI anti-HIV drugs (AZT, ddI,
ddC, d4T, 3TC, abacavir) can - very rarely - cause a severe and
potentially life-threatening liver problem called lactic
acidosis. Symptoms of lactic acidosis are severe nausea,
vomiting and rapid breathing. A blood measurement called serum
bicarbonate can also be used to help diagnose this problem.
Serum bicarbonate levels often drop below normal levels as a
result of lactic acidosis. If this problem occurs it requires
stopping and replacing the offending NRTI drug.