Question:

Respected Sir/Madam,
My questions are as follows:

1. Which organs are worse affected by HARRT?
2. HARRT cause mat absorption of which nutrients?
3. Which nutrient intake should be increased in AIDS?
4. What effect of HARRT is on ESR (erythrocyte sedimentation rate)?
5. What effect of AIDS is on ESR?
6. Which factors can increase CD-4 count?
7. Is surgery of Gall Bladder is possible in AIDS?

Answer provided by:

Peter Shalit, M.D.
Internal Medicine

1. Ideally, HAART should not injure or damage any organs. The most common serious toxicity of HAART is liver injury. This can be caused by protease inhibitors, NNRTI's, or NRTI's. This tends to be an early toxicity rather than a cumulative toxicity. Hence monitoring of liver function is important in the weeks after initiating HAART. Other organs, such as the kidneys, skin, and bone marrow, can sometimes be injured by certain components of HAART, but this is less common. Fat loss and/or accumulation sometimes accompanies HAART, and may be symptom of mitochondrial toxicity caused by certain nucleosides (the dideoxynucleosides - DDI, DDC, and D4T). Protease inhibitors may also be associated with changes in body fat distribution.

2. HAART does not usually cause malabsorption of nutrients. Sometimes HAART can cause diarrhea, but even then I am not aware that this produces a nutritional deficiency except perhaps in extreme cases.

3. There are no specific nutrients that should be increased in AIDS. However, in AIDS wasting syndrome, protein/calorie malnutrition can occur. People affected by this syndrome do best to consume calorie-dense foods (high in protein and fat content). A recent study also suggested that a multivitamin supplement can delay progression to AIDS in women who are not receiving HAART.

4/5. AIDS by itself does not increase ESR significantly, in my experience. A high ESR in the setting of AIDS usually is a reflection of a secondary opportunistic problem. HAART does not influence ESR.

6. HAART is the only treatment that predictably increases CD4 count. Other therapies, such as nutritional therapy or lifestyle modification, does not predictably increase CD4 count.

7. Gall bladder surgery is certainly possible in AIDS and is frequently performed. In my experience there is an increased incidence of postoperative fever and wound infection, but this has not been a barrier to performing this surgery.

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