chemistry

HIV disease–related drug reaction

HIV disease–related drug reaction is a chemistry topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand HIV disease–related drug reaction rather than just read about it. In short: HIV disease–related drug reaction is an adverse drug reaction caused by drugs used for the treatment of HIV/AIDS. Drug reactions are a major cause of mortality and morbidity around the world.

Key takeaways

HIV disease–related drug reaction belongs to chemistry; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect HIV disease–related drug reaction to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of HIV disease–related drug reaction from memory before moving on to harder problems.

Reference excerpt

HIV disease–related drug reaction is an adverse drug reaction caused by drugs used for the treatment of HIV/AIDS.

Drug reactions are a major cause of mortality and morbidity around the world. Special populations of people, such as those who are HIV-positive, can be up to a hundred times more susceptible to immune-mediated adverse drug reactions than the general public.

Types of Reaction and offending medication

Immune-mediated drug hypersensitivity Commonly prescribed medications for HIV, such as sulfonamides, anticonvulsants, antibacterials, antifungals, antimycobacterials, and, most notably, antiretrovirals, have an increased incidence of adverse cutaneous drug reactions in HIV-positive individuals, and even greater escalation of incidence in people with advanced disease progression in the form of AIDS. The specific mechanism for how HIV infection increases risk of drug reactions in HIV-positive individuals is unclear. Many factors contribute to this increased risk of adverse drug reactions found among people with HIV. Some explanations involve poly-pharmacy, slow acetylator status, glutathione deficiency, etc. In addition, it is also thought to be caused by immune hyperactivation, altered immunoregulatory pathways, reactivation of comorbid herpes viral infections, altered redox balance, uncontrolled immune activation, and loss of CD4+ T-helper cells. There is no single defined cause for this association. Some prescription medications are more likely to cause these adverse drug reactions than others. Non-nucleoside reverse transcriptase inhibitors have been shown to have the highest rate of causing immune-related drug reactions in people who are HIV positive. Trimethoprim-sulfamethoxazole, also known by the brands Bactrim or Septra have caused adverse cutaneous drug reactions at an incidence of 2.6%-8% in the general population, but 43%-69% in patients with HIV infection or AIDS. A retrospective study of adult patients with Pneumocystis jirovecii pneumonia and AIDS who were admitted to Veterans General Hospital in Taiwan between January 2006 to December 2011 and treated with trimethoprim-sulfamethoxazole demonstrated a high incidence of adverse drug reactions that mostly involved the skin and liver. Significant risk factors were daily dose of greater than 16 mg/kg of trimethoprim-sulfamethoxazole and an age of 34 or older.

Drug-induced liver injury The use of antiretroviral therapies have decreased the risk of early mortality and improved the quality of life for people who are HIV-positive. A significant increase in the use of these medications have been seen over the years, from an estimated 7.7 million people receiving these antiretrovirals therapies in 2010, to approximately 24.5 million estimated people worldwide in 2018. Despite the success in efforts to treat and control the disease with these medications, there are reports of people who received treatment and developed a severe adverse drug reaction such as a drug-induced liver injury (DILI). Antiretrovirals including non-nucleoside reverse transcriptase inhibitors (NNRTIs) and transcriptase inhibitors (NRTIs) have been reported to cause DILI in people with HIV. Genetic variations in drug metabolizing enzymes are associated with a higher risk of adverse drug reactions in people with HIV taking antiretrovirals, and it may become recommended under the practice of precision medicine to screen for genetic susceptibility to adverse effects based on these enzymes. The reported incidence of antiretroviral therapy induced liver injury range from 8%-23% in people with HIV. Among these people, 30% had needed to have a change in the medication plan or even discontinue their current therapy. Drug-induced liver injury is a common cause of prolonged hospital stays for people with HIV, and in more severe reactions can be life-threatening. Antiretrovirals may also cause damage to cells in a person with HIV, decreasing function of crucial cells and releasing toxins in the body. Thus, discontinuing the offending medication may cause loss of control in viral load and ultimately treatment failure. Studies have reported that efavirenz is a potential agent that caused drug induced liver injury in HIV-positive patients taking the first line antiretroviral therapy of efavirenz/tenofovir disoproxil fumarate/emtricitabine fixed‐dose combination. Other reported risk factors for drug induced liver injury are female gender, young age, and high CD4+ count of >200 cells/mm3. All classes of antiretroviral medications could cause drug induced liver injury, but some classes of medications may be more toxic than others. Further research is needed to better understand and analyze any potential differences in risk levels between these classes of antiretrovirals.

Diagnosis Diagnosis of HIV drug caused drug induced liver injury (DILI): The most important way to figure out whether the ART drug causes the drug DILI is to do the blood test to see the AST and ALT level. If the AST and ALT level increase, the HIV drugs are causing the hepatotoxicity. In addition to the high level of AST and ALT level, the bilirubin and gamma-glutamiltranspeptidase (GGT) may also increase when doing the ART HIV treatment. Normally, the hepatic toxicity may be suspected if the bilirubin and GGT levels are higher than the normal level. However, some studies has shown that the ART drug may inhibit the UDP-glucuronosyltransferase, which causes the indirect and total bilirubin to increase. Moreover, the increase of GGT may be the indication of cholelithiasis and the cholelithiasis could be further worse to damage the hepatocyte. However, increasing the GGT may have variable reasons and the mechanism of how ART causes high GGT is still unknown, but the gold standard to determine if the cholelithiasis occurs is the alkaline phosphatase. Diagnosis of zidovudine related anemia: zidovudine counters HIV in two ways. It can directly inhibit reverse transcriptase from converting viral RNA to DNA so that HIV cannot integrate into human DNA. In addition, zidovudine works as a DNA replication chain terminator. Because of its DNA chain terminator feature, the bone marrow may be suppressed so that its production of red blood cells is decreased. Moreover, zidovudine may also increase the destruction of red blood cells, which may continue to decrease the red blood cell count.

… excerpt ends here. Continue reading the full article.

Illustrations

Worked examples

Example 1 — a first encounter with HIV disease–related drug reaction

Start with the simplest possible case. Write down what HIV disease–related drug reaction claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In chemistry, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to HIV disease–related drug reaction before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about HIV disease–related drug reaction ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of HIV disease–related drug reaction

In research: HIV disease–related drug reaction appears in chemistry research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses HIV disease–related drug reaction in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: HIV disease–related drug reaction is common in secondary-school and first-year university syllabi. It links to neighbouring topics Drug eruptions, HIV/AIDS, so understanding it makes those chapters shorter.
In everyday life: Look for HIV disease–related drug reaction outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study HIV disease–related drug reaction in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what HIV disease–related drug reaction means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain HIV disease–related drug reaction out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is HIV disease–related drug reaction in simple terms?

HIV disease–related drug reaction is an adverse drug reaction caused by drugs used for the treatment of HIV/AIDS. Drug reactions are a major cause of mortality and morbidity around the world.

Why does HIV disease–related drug reaction matter?

Because it connects several chemistry ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study HIV disease–related drug reaction?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on HIV disease–related drug reaction.