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Common types of HIV disease-related reaction: dermatological, hepatic, hematological, weight loss and fever, nervous system, metabolic, ear, heart, muscle and GI tract.

There are different types of drugs that can cause those common types of HIV disease-related reaction. The first class of drug that can bring most adverse reactions is the anti-tubercular (ATT) drug, which includes ethambutol, isoniazid, pyrazinamide and rifampicin. The adverse effects that the ATT drugs may bring to the patient include hepatitis or hepatitis with encephalopathy, fever, rash, nausea and vomiting.

The second drug that may bring some common adverse reaction to the patient is the zidovudine, which is used to inhibit the HIV reverse transcriptase enzyme competitively to stop of the reproduction of HIV virus. Moreover, it can also work as DNA replication terminator. The adverse effect that zidovudine may cause includes:

the drug that cause these common reactions in people with HIV treatment: anti-tubercular drug, including ethambutol, isoniazid, pyrazinamide, rifampicin;

zidovudine, nevirapine, efavirenz.

anti-tubercular (ATT) drug, ethambutol, isoniazid, pyrazinamide and rifampicin: hepatitis or hepatitis with encephalopathy, fever, rash, nausea and vomiting.

AE of zidovudine includes: anemia, lactic acidosis, proximal myopathy

AE of nevirapine includes: rash, Stevens-Johnson syndrome, fever, hepatitis.

AE of Efavirenz: weight loss and giddiness.

Types: Anemia

Causes: The use of zidovudine (ZDV) has been shown to increase the chance of having anemia. The study has demonstrated that compared to the HIV patient receiving non-ZDV treatment, HIV patients who receive ZDV are more likely to have severe anemia.

Types: Lactic acidosis

The use of nucleoside reverse transcriptase inhibitor (NRT) can potentially increase the lactate production because NRT is able to disrupt the normal mitochondrial breathing pathway based on the bench study. Moreover, the bedside clinical study further indicates the cause and effect association between the NRT and the lactic acidosis.

Mechanism: Because the NRTIs can impair the normal mitochondrial pathway and disrupt the NAD+/NADH cycle, these can further impair the lipid beta-oxidation and oxidative phosphorylation. Thus, the long chain fatty acid is unable to be broken down so that the pathway needs to be changed to glycolysis. The excess glycolysis can produce the excessive lactic acid, leading to the lactic acidosis eventually.

NRTIs can disrupt the

Diagnosis of lactic acidosis:

There are a couple of standard to do the diagnosis of lactic acidosis, which will be listed in the following.


 * 1) Blood pH < 7.35
 * 2) lactate level > 45-54mg/dL
 * 3) Increased Anion gap

There are two types of lactic acidosis that are most commonly seen in the real clinical setting and they are type A and type B lactic acidosis. Type A lactic acidosis is mainly caused by the systemic ischemia since the oxygen has trouble being delivered to the tissue so that most of the biochemistry pathway will be shifted to the glycolysis pathway to generate ATP. Therefore, this shifting can increase the lactic acid level and lead to the lactic acidosis. However, the type B lactic acidosis is most likely caused by the exogenous toxins, such as the NRTI. Therefore, when diagnosing the lactic acidosis, the health providers need to differentiate between the type A and type B lactic acidosis carefully so that we can treat the lactic acidosis with the best treatment plan.

In order to differentiate the type A and type B lactic acidosis, we can do more imaging and blood tests to see if patients are experiencing any ischemia condition. If not, we can eliminate

Mechanism of ZDV related anemia: The ZDV works in fighting against the HIV mainly in two ways. The first way is that it can directly inhibit the reverse transcriptase from prohibiting the virus RNA to convert to DNA so that HIV virus cannot integrate into the human DNA. In addition, the ZDV also works as the DNA replication chain terminator. Because of its DNA chain terminator feature, the bone marrow may be in the suppression condition so that the new red blood cell may have trouble being produced. Moreover, the ZDV may also increase the destruction of the red blood cell, which may continue to decrease the red blood cell count.

Diagnosis of ZDV related anemia


 * 1) Complete blood count
 * 2) Blood smear

The result of the blood smear of ZDV related anemia usually comes up with megaloblastic macrocytic anemia.