Concerns about HAART
(Highly Active Anti-Retroviral Therapy)

HAART is the therapy, composed of multiple anti-HIV drugs, that is prescribed to many HIV-positive people, even before they develop symptoms of AIDS (and without considering that many will never develop these symptoms). The therapy usually includes one nucleoside analog (DNA chain terminator), one protease inhibitor and either a second nucleoside analog ("nuke") or a non-nucleoside reverse transcription inhibitor (NNRTI).

Adverse Effects, in General

The list of side effects of HAART (Highly Active Antiretroviral Therapy) is so long, that it is impossible to categorize all of them. Further, some papers document side effects in a number of categories. The quotes below illustrate this.

"There is also increasing recognition that adverse events associated with antiretroviral treatment remain an important source of morbidity and even mortality, such as in advanced disease, in which non-AIDS serious adverse events continue to outweigh AIDS-related events in frequency and overall detrimental effects on quality of life."

Complications of antiretroviral therapy. XV International AIDS Conference. 2004 Aug 27.

Adverse Effects with Nucleoside Analogs ("Nukes")

Also see information specifically related to AZT in <a href="http://www.aras.ab.ca/azt.html">azt.html</a>.

"this rare but often life-threatening syndrom, now named ‘severe nucleoside-associated lactic acidosis' (NALA) has been reported increasingly often. Hepatic steatosis [loss of fat in liver] and lactic acidosis are thought to be caused by nucleoside reverse-transcriptase inhibitor (NRTI)-associated mitochondrial toxicity...Low levels of hyperlactatemia have been reported in 21% of NRTI-treated patients, although the majority of these patients are

"Bristol Myers Squibb (BMS) has chosen to inform doctors of rapidly ascending muscular weakness as new symptom of nucleoside-related lactic acidosis and hyperlactataemia

Rapidly ascending neuromuscular weakness associated with nucleoside analogues. HIV Treatment Bulletin. 2001 Oct;2(8).

"Pancreatitis occurs with a frequency of 1 to 7% with the currently recommended doses of didanosine...Our analysis demonstrated that the use of hydroxyurea was associated with an adjusted fourfold increase in the risk of pancreatitis compared with patients on didanosine alone...There was one fatal case in a patient on didanosine + stavudine + hydroxyurea "

Adverse Effects with Protease Inhibitors

Protease Inhibitors were described as miracle drugs when they first were made available in late 1995. However, the miracle turned out to be a mirage, as a whole range of new side effects, particularly metabolic abnormalities, were discovered. As with all AIDS drugs, this should not have been a surprise, because they are tested for only a short time, in order to rush them to market.

"Participants who initiated therapy with a protease inhibitor were 2.02 times more likely to die than those who did not start therapy with this class of drug "

Hogg R et al. Rates of Disease Progression by Baseline CD4 Cell Count and Viral Load After Initiating Triple-Drug Therapy. JAMA. 2001 Nov 28;286(20):2568-77.

Blood Disorders

HAART can be toxic to blood because it almost always includes one or two nucleoside analogs, drugs like AZT that are notorious for their toxicity to red and white blood cells and blood cell production. Various forms of anemia are very common and sometimes are irreversible.

Bone Disease

HAART can have debilitating effects on the bones of people that take these drugs.

"Bone disorders in HIV-1 patients treated with highly active antiretroviral therapy (HAART) are an emerging issue...After approximately 27 months of treatment with indinavir (800 mg three times a day), zidovudine [AZT] and lamivudine [3TC], a 56-year-old HIV-1-infected bisexual man noticed thickenings on almost all fingers of his hands. He also noted several small protrusions at the costosternal [breastbone] junctions...After the introduction of indinavir [a protease inhibitor] in June 1998, the patient experienced myalgia [muscle pain], arthralgia [joint pain], dry skin, body hair loss, and ingrown toenails developed. The patient has also been taking trimethoprim-sulfamethoxazole...