HCV:
The Correctional Conundrum
(continued)
Selected Antiretroviral
Toxicities and Monitoring
Lactic Acidosis and Hepatic
Steatosis
Women are at higher risk
for severe lactic acidosis and hepatomegaly with steatosis. Although
rare, these conditions are serious and potentially fatal complications
of nucleoside analogue reverse transcriptase inhibitor (NRTI) therapy.18
Risk factors for this syndrome include gender (female), obesity, and prolonged
NRTI therapy.19 Clinical symptoms are non-specific, but can include nausea,
bloating, abdominal pain, anorexia, vomiting, diarrhea, malaise, and weight
loss. Because of the difficulty in obtaining an accurate lactate level,
monitoring is mainly by clinical symptoms and monitoring the electrolytes
(for acidosis) and liver chemistries every three months or when symptoms
consistent with the syndrome are present.
Fat Maldistribution
Fat maldistribution can
be particularly problematic for HIV-infected women when it is manifested
as breast enlargement or central obesity, contributing to musculoskeletal
back pain and negative body image. The actual incidence of fat maldistribution
in patients receiving HAART is unknown as lack of a standardized definition
make diagnosis difficult, but estimates range from 6% to 80%. Clinical
finding include central obesity, breast enlargement, cervicodorsal fat
accumulation (buffalo hump), peripheral fat wasting with extremity wasting
and vascular prominence, and facial thinning.20,21,22 All of these morphologic
changes develop gradually, usually after several months of therapy.
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