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The ABCs of Drug Side Effects.

Lipodystrophy

Lipodystrophy is a broad term used to describe a range of body fat changes and metabolic problems that are linked to use of anti-HIV drugs, especially protease inhibitors. Experts like to distinguish fat gain (lipohypertrophy) from fat loss (lipoatrophy), since both can occur in someone at the same time and affect different parts of the body, including under the skin (subcutaneous), in the face, neck, arms and legs (peripheral) and stomach (called central or truncal adiposity).

Lipodystrophy is also linked to distinct side effects such as high cholesterol levels and insulin resistance that leads to diabetes; mitochondrial toxicity; bone weakness; and lactic acidosis. (see below)

What causes lipo? The exact cause is unclear, but somehow the metabolism (breakdown or processing) of anti-HIV drugs affect fat cells, including those in the liver. A new report in children shows a link to impaired growth hormone secretion (GH). Some experts suggest monitoring for GH secretion in children and using recombinant GH therapy for those with excessive intra-abdominal fat loss. The strategies are being evaluated for adults.

How do you diagnose lipo? There are several diagnostic tests that measure body fat and tissue and evaluate levels of cholesterol, insulin, and certain body enzymes. A DEXA scan uses imaging technology to measure whole body composition.

Mitochondrial toxicity

Mitochondrial Toxicity refers to damage to the body's mitochondria (the energy producing units of cells). Studies show that anti-HIV drugs, especially nucleoside analog drugs, or nukes, lead to a loss of mitochondriat DNA and cell damage.

Bone problems

Bone cell loss is measured on a scale ranging from mild (Osteopenia) to more severe (Osteoporosis) that indicate the risk of a fracture. A BMD test (Bone Mineral Density) measures bone strength, based on the density of bone cells. A BMC test (bone mineral content) measures which bone cells are affected.

Lactic acidosis

Lactic Acidosis is a rare, potentially fatal and rapidly progressing illness caused by an abnormal increase of lactic acid (or lactate) in the blood. It has been reported with all the nucleoside analog drugs. The most common side effects of lactic acid are sore muscles, nausea, vomiting, severe fatigue, rapid, deep breathing, abdominal pain, cramping and numbness or tingling, and muscle weakness (myopathy) that quickly gets worse.

Doctors are careful to distinguish lactic acidosis, an extreme condition, from elevated lactate levels (hyperlactemia), which is a common finding in people taking antiretroviral drugs. There is a relationship between mitochondrial toxicity and lactic acidosis: when damage occurs to mitochondria (the energy producing unit of cells), muscle cells are forced to get their energy without oxygen (anaerobic) and produce lactic acid as a waste product. This causes the soreness in muscles and cramping in runners who finish marathons, for example. It has been reported in people on anti-HIV therapy who also develop lipodystrophy and get fatty livers. Lactic acidosis can also cause kidney damage and hearing loss.

Diagnosing Lactic Acidosis: A blood test exists to measure lactic acid (lactate) levels, but experts are divided about how useful it is to diagnose test results, since doing exercise (climbing stairs, walking quickly) before taking the test can increase lactic acid levels. Lactate levels over 5 mmol/L in the presence of symptoms can indicate progressing lactic acidosis.

For more information

For easy-to-read information on side effects and other aspects of HIV therapy, check the New Mexico AIDS Information Website (www.aidsinfonet.org).
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Author:d'Adesky, Anne-Christine
Publication:WORLD
Date:Mar 1, 2003
Words:561
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