The use of highly active antirretroviral therapy (HAART) has helped to reduce complications from AIDS in North America and Western Europe. Unfortunately, however, HAART-users can experience a range of side effects, including the following — which collectively is called the lipodystrophy syndrome:
Hampering efforts to understand why these side effects occur is the fact that people with HIV/AIDS (PHAs) are often taking combination therapy made up of treatments from at least two of the following groups of drugs:
PHAs who are also co-infected with hepatitis C virus (HCV) may also be using interferon-alpha and the anti-HCV nuke ribavirin (Virazole).
Even though treatment regimens can be complex, researchers around the world are beginning to develop ideas about some of the causes of drug side effects. Below are some brief explanations.
Nukes can damage the energy-producing parts — called mitochondria (Mt) — of a cell. Over time, with continued exposure to nukes, damaged Mt become dysfunctional and dwindle in number. The end result is that a cell has less energy with which to do its work. Cells experiencing this kind of energy shortage don't work properly and can die. Here are some examples of what can happen in cases of Mt damage:
In the time before lipodystrophy became a common problem for PHAs, Mt damage also appeared in other, HIV negative people, particularly those with neurologic problems. In such cases, doctors used the following substances to treat Mt damage:
Use of another group of anti-HIV drugs called protease inhibitors (PI) appears to increase the risk of type 2 diabetes and possibly heart disease by increasing levels of fatty substances in the blood. The role that non-nukes play in the HIV-lipodystrophy syndrome is not clear.
In this section of TreatmentUpdate 123, we present highlights from the 3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 23-26 October 2001. We will be focusing on the following issues:
In the following issue of TreatmentUpdate, further reports from this conference will appear, covering such aspects as:
Unless otherwise noted, all references are from the lipodystrophy workshop.
REFERENCE
Spellberg B, Carroll RM, Robinson E and Brass E. mtDNA disease in the primary care setting. Archives of Internal Medicine 2001;161:2497-2500.
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