“I just had a dental checkup yesterday. Damn depressing.... The dentist told me all my teeth's enamel had been eaten up by the drugs; that I had so many cavities he was wondering how I could manage to eat and sleep; and that it was beyond his capacity to do anything. When I got out I was crying like a baby. We looked at the xrays. I got cavities directy in the bones. He's flabergasted by the unexpected side effects. Has anyone heard of this shit with crix [Crixivan, a protease inhibitor], 3TC [a nucleoside analog] and d4t [a second nucleoside analog] combo?”
C.M. hivthrivers support group via email. 2000 Apr 7.

“One of the major barriers to effectively treating HIV is that most people do not feel sick at the time that they are offered anti-HIV medications. In fact, it is only after starting the medications that they begin to feel sick...Side effects, onset of new diseases caused by the treatment for HIV and the immense pill burden are new problems that many individuals with HIV must adapt to. The lives of many patients have become governed by their drug ‘cocktails’, which for some patients involves as many as 40 pills a day.” 
Swick L. Advances in HIV treatment a mixed blessing. The Toronto Star. 1999 Sep 24.

“Liver disease has become the leading cause of death among HIV patients at a Massachusetts hospital, a report issued on Friday...[by] Dr. Barbara McGovern, a professor at Tufts University School of Medicine and a member of staff at Lemuel Shattuck Hospital in Jamaica Plains, Mass. The findings were reported on Friday at the annual meeting of the Infectious Diseases Society of America in Philadelphia. McGovern said HIV patients who take a powerful combination of AIDS drugs called highly active antiretroviral therapy (HAART) were at particular risk because of the drug's potential toxicity to the liver. One-third of HIV patients with underlying liver disease at Lemuel Shattuck have had to stop taking HAART.”                                                                 
 Liver disease raises questions for AIDS patients. Reuters. 1999 Nov 19.

“...we examined 304 anti-retroviral-experienced patients who were placed on HAART for a period of 18 months. The baseline CD4 count was 385x10(6)/1 and HIV RNA level was 3.2 log[10] copies/ml. At baseline, 39 percent were classified as asymptomatic, 33 percent were symptomatic, and 28 percent had an AIDS defining illness. The HAART regimens included 3-5 anti-retroviral agents at least one of which was a protease inhibitor...After 18 months, 14 percent of the population remained asymptomatic, 10 percent of which had an undetectable viral load. 39 percent were symptomatic and 47 percent of the population had an AIDS defining illness. The average CD4 count after 18 months on HAART was 301.79x10(6)/1 and HIV RNA level of 3.2 log[10] copies/ml. [i.e. HAART did not prevent progression, reduced CD4 counts and did not affect HIV RNA levels]”                                                                                                              
Ramirez CM, Gottlieb MS. Long-Term Highly Active Anti-Retroviral Therapy in an Anti-Retroviral Experienced Population. AIDS Weekly Plus. 1999 Jun 28.

“HAART use had an independent effect on REE [Resting Energy Expenditure]." and "Compared with the subjects who were not on HAART, the adjusted REE was 339 kJ/day higher in the patients receiving HAART.”                                                               
Shevitz AH, et al. Elevated resting energy expenditure among HIV-seropositive persons receiving highly active antiretroviral therapy . AIDS. 1999 Jul 30;13(11):1351-7.

“The incidence of diarrhea was 14.2 per 100 person-years (95% confidence interval, 13.0-15.4). Among patients with CD4 cell counts below 0.05 x 10**9/L, the probability to develop diarrhea within 1, 2, and 3 years was 48.5%, 74.3%, and 95.6%, respectively. The risk to develop diarrhea was increased among patients with severe immunodeficiency, homosexual men, and patients taking antiretroviral therapy...Diarrhea was an independent negative predictor of survival.”                                                    
Weber R et al. Enteric Infections and Diarrhea in Human Immunodeficiency Virus-Infected Persons. Arch Intern Med. 1999 Jul 12;159:1473-80.

“In the era of HAART (highly active antiretroviral therapy), we're seeing less of the common oral lesions but an increase in oral warts caused by the human papillomavirus...We do not understand why this is happening.”                          
Greenspan, et al. Abstract #704: Emergence of Oral Warts in the HAART Era. 6th Conference on Retroviruses and Opportunistic Infections. 1999 Feb.


“The use of antiretrovirals and PCP prophylaxis before AIDS were associated with a significantly poorer survival after AIDS [median of 16 months before death with antiretrovirals, 25 months without].”                                                                               
van Benthem BHB et al. Is AIDS a floating point between HIV seroconversion and death? Insights from the Tricontinental Seroconverter Study. AIDS. 1998 Jun 18;12(9):1039-1045.

“highly active antiretroviral therapy, which includes two nucleoside reverse-transcriptase inhibitors and a protease inhibitor, has been associated with an increased risk of potential cardiovascular complications that was related to the length of protease-inhibitor treatment and the type of protease inhibitor used. In approximately 60 percent of patients who were treated with this type of therapy, complications such as lipodystrophy, insulin resistance, and high cholesterol and triglyceride levels developed. In 10 to 20 percent of patients these complications were severe. There is also anecdotal information suggesting that the risk of angina and myocardial infarction is increased with high active antiretroviral therapy.” 
Lipshultz SE. Dilated Cardiomyopathy in HIV-Infected Patients. NEJM. 1998;339(16):1153-5.

“The faster disease progression and the higher speed of CD4 cell decline at early stages in the patients with recently acquired HIV infection suggest changes in the clinical course of HIV infection. [apparently the possibility that drug treatments could be causing this was not considered.]”                                 
Sinicco A et al. Is the clinical course of HIV-1 changing? Cohort study. BMJ. 1997 Apr 26;314:1232-1237.

“Overall rates [of adverse drug reactions] ranged from 16.2 to 37.0 events for 100 person-years of follow-up on [Zidovudine, Didanosine, Zalcitabine, Cotrimoxazole, Dapsone]. For all of these drugs except dapsone, there was an increasing risk of adverse events as the CD4+ count declines.”
Moore RD, et al. Adverse events from the drug therapy for human immunodeficiency virus disease. American Journal of Medicine (JAMA?). 1996 Jul;101:34-40.

“The survival of patients in group B [symptomatic at time of HIV diagnosis] after the onset of AIDS was significantly longer than that of patients in group A [asymptomatic at the time of diagnosis] as determined by Kaplan-Meier log rank analysis (P = 0.0026) [i.e. does exposure to antiviral therapy earlier make AIDS worse?]” 
Poznansky MC et al. HIV positive patients first presenting with an AIDS defining illness: characteristics and survival. BMJ. 1995 Jul 15;311:156-8.