Selected highlights from the 4th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
Nucleoside analogues (nukes or NRTIs) such as AZT, d4T and ddI may be associated with a number of side effects, including the following:
Some researchers think that these problems occur because nukes damage the energy-producing parts of cells called "mitochondria" (Mt). Large numbers of damaged or malfunctioning Mt produce lactic acid (lactate). When high levels of lactic acid in the blood occur, this is known as "lactic acidosis." Generally, this condition is uncommon in PHAs. People with hepatitis B or C are at increased risk for developing lactic acidosis. Symptoms of lactic acidosis include the following:
The following blood tests help identify lactic acidosis:
If left untreated, lactic acidosis can be deadly.
Reseachers in San Diego, California, conducted a study to find out if switching nukes (more about this later) in a combination could help PHAs with one or both of the following:
All 118 HIV positive subjects had suppressed viral loads and had been using d4T as part of HIV combination therapy for at least six months when they entered the study. All subjects were switched from the nuke d4T to either AZT or abacavir.
Sixteen subjects had high lactic acid levels (more than 2.2 mmol/L) and took a temporary drug holiday (for about a month) until lactic acid levels returned to normal. Once this happened, they resumed therapy, with the d4T in their combination replaced by either AZT or abacavir.
Results — lactic acid
About 93% of all subjects continued to achieve low viral loads up to one year after the switch. No further cases of high lactic acid levels developed, although eight cases of abacavir hypersensitivity occurred.
Special X-ray scans, called DEXA, taken of the legs and trunks of some subjects detected increased subcutaneous fat levels one year after the d4T switch. However, these increases were generally not obvious to the naked eye.
REFERENCE
Lonergan T, McComsey G, Hessenthaler S, et al. Lack of recurrence of symptomaticand asymptomatic hyperlactatemia when stavudine is replaced by either abacavir or zidovudine: 48-week data. Abstract 21.
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