Emerging Complications of Hiv Therapy:

There are several side effects of Hiv medications that lead to a concern for an increase in the risk of cardiovascular disease,including heart attacks and strokes.This includes an increase in blood lipids,increases in blood sugar,and a general inflammatory state that Hiv induces.
It was known previously that even when untreated,Hiv leads to disturbances in blood lipids,including lower cholesterol (both HDL and LDL) and an increase in triglycerides.
However,it is well established that at least some antiviral medications also cause these values to change,and usually in directions that are anticipated to increase the risk for problems down the road (e.g.,higher cholesterol and triglycerides).
However,we still have only limited data to demonstrate that these drug-induced changes are leading to problems.Sensitive testing,such as looking at blood vessels or their function,has inconsistently picked up early evidence of problems,with some tests showing no changes in the vessel walls despite revealing changes in blood fats.In addition,studies of large populations have sometimes noted higher rates of heart attacks.But in at least one study,this increase was not associated with any specific treatment itself,but rather just an overall impact of having Hiv infection.It is,however,
fair to say that it may take several years before these blood fat changes would have a measurable impact on blood vessel walls,and so the lack of these early changes must be viewed with some caution.
Hepatitis,or liver disease,is a second area of concern.Clearly the epidemics of hepatitis C and B can rage alongside the Hiv epidemic.In terms of antiviral medication use,what has been noted overall is that about 6 percent of people co-infected with Hiv and hepatitis have serious problems of hepatitis in the absence of these other known viral causes.There is some evidence that anti-Hiv medications play some role in this for a percentage of people.However,the added burden of hepatitis C makes anti-Hiv medications harder to use,for example,increases in liver function tests associated with nonnucleosides are triple the rate in those with hepatitis C verses those without hepatitis C.
Bone disease,especially thinning of the bone (osteopenia) is an emerging area needing careful monitoring.Of note again,Hiv appears to be associated with an increased risk for this condition.One study presented last year showed about a 10 percent higher risk of osteopenia and the more severe osteoporosis in those with untreated Hiv infection.Again,anti-Hiv medications may aggravate this problem,as animal studies have suggested a link between decreased bone formation and at least some medications.