10/28

I was shocked by the variety of adverse events that can occur during HAART treatment. In under-served populations already lacking in basic adequate healthcare, some of these deficiencies could prove almost as harmful to quality of life as infection with the HIV virus in the first place. Some, like hepatitis, pancreatitis, and anemia, could interfere with basic health by limiting proper nutrition through inadequate digestive function. Others, like a rash, seem less harmful from a medical standpoint, but could contribute to the augmentation of the preexisting sigma surrounding HIV positive individuals. Indeed, 79.3% of individuals who developed a rash (arguably less dangerous than many of the other conditions) stopped treatment within the first month.

I did not know what some of the adverse events mentioned in this article were; so I did some research. Lactic acidosis, experienced by 24.4% of women who stopped treatment, is a buildup of lactic acid in the blood that can cause gastrointestinal symptoms. The underlying cause of this phenomena when caused by antiretroviral drugs is mitochondrial toxicity. Apparently, NRTIs can interfere with an enzyme needed in the production of mitochondria, leading to a significant decline in their number, and less efficient conversion of cellular energy as a result.

SJS, also mentioned in the article, is an epidermal disease that is also caused in most cases by adverse drug reactions. The disease is often misdiagnosed early on as the patient develops lesions in the mucous membranes, and then the patient's skin can actually begin to separate from the lower layers of the dermis. The condition can be life-threatening if not diagnosed and treated in time.

Lipodystrophy is an often unavoidable side-effect of antiretroviral treatments, wherein the patient precipitously loses fat from the face, sometimes developing lumps in the back of the neck.

Peripheral neuropathy is damage to the peripheral nervous systems. In this case, the toxicity exhibited by many of these drugs leads to neurochemical dysfunction. This can manifest itself in a variety of ways, from numbness or tingling to loss of function and partial paralysis. Certain antidepressant drugs meant to work in the CNS have been shown to reduce the incidence of pain related to peripheral neuropathy, but, once again, diagnosis is key.

As stressed by Kumarasamy et al. in this article, it is clearly critical for clinics to monitor for early signs of toxicities in their patients. Admittedly in resource-limited regions, this prospect seems daunting at best.

Katie Nelson