Hyperlactatemia and human immunodeficiency virus infection: lessons from the era of antiretroviral monotherapy

Nausea and vomiting in HIV/AIDS

HIV infection has become a chronic illness with the availability of potent antiretroviral agents. Many of the agents used to manage HIV, however, have been associated with distressing symptoms such as nausea and vomiting posing challenges to maintain adherence to therapy and quality of life. This article highlights the mechanism, evaluation, and management of HIV-associated nausea and vomiting. Supportive symptom management information is also presented.

Antiretroviral therapy-induced liver alterations

PURPOSE OF REVIEW

Antiretroviral drugs are associated with hepatotoxicity. Progress in our knowledge on the prevalence, contributory factors and mechanisms is reviewed.

RECENT FINDINGS

Liver toxicity is highly prevalent and a major cause of hospitalization among HIV-infected individuals. Liver steatosis is probably more frequent in the setting of hepatitis C virus coinfection but is also seen in noncoinfected patients. Among the individual drugs, severe liver toxicity is more strongly associated with nevirapine, and the mitochondrial toxicity of some nucleoside analogues. Mitochondrial toxicity can also induce or contribute to steatohepatitis, with dietary uridine supplementation as a possible strategy of prevention. Atazanavir inhibits UDP-glucuronosyltransferase, which in Gilberts' syndrome has been associated with breast cancer. A UDP-glucuronosyltransferase gene promoter variant predisposes to hyperbilirubinemia. Tipranavir induces elevated transaminases more frequently than boosted comparator protease inhibitors. CCR5 inhibitors may predispose to hepatotoxic events by causing an imbalance in the cytokine response.

SUMMARY

Hepatotoxicity is associated with all classes of antiretroviral agents and continues to contribute to hospitalization.

Metabolic acidosis in AIDS patients

BACKGROUND AND AIMS

Metabolic acidosis (MA) is a frequent and serious complication in HIV-infected patients. The aim of the study is to compare patients with and without MA associated with HIV.

METHODS

Patients were retrospectively studied involving all HIV-infected patients with blood gas analysis performed during hospital stay admitted to a single hospital between April 2004 and July 2006. Statistical analysis was performed using SPSS 10.0 for Windows.

RESULTS

Included in the study were 159 HIV patients, 72 cases (45.3%) with MA and 87 cases (54.7%) without. The comparison of both groups showed a mean arterial pH of 7.24 +/- 0.08 vs. 7.44 +/- 0.05, HCO(3) 12 +/- 5.7 vs. 21 +/- 5.1 mEq/L, serum urea 81 +/- 68 mg/dL vs. 39 +/- 46 mg/dL and serum creatinine 2.7 +/- 2.6 mg/dL vs. 1.2 +/- 1.9 mg/dL in MA-HIV and non-MA-HIV, respectively (p <0.05). Antiretroviral therapy (ART) was being administered to 38 subjects (52.8%) in MA-HIV group and 45 (51.7%) in non-MA-HIV group (p = 0.57). There was no association between the use of ART and MA. Mortality was higher in patients with acidosis (52.7 vs. 17.2%, p <0.0001).

CONCLUSIONS

In the present study, MA was associated with acute kidney injury and increased mortality. There was no association between the use of ART and MA.