NAPWA

Symptoms

Generalised pain, swelling and tenderness in the muscles and tendons. Muscles may be more easily bruised and harder to heal. Symptons include vague or mild muscle pains and aches. Muscles may also reduce in size as a result of muscle wasting from some HIV antiviralA medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. drugs. Sometimes, extreme muscle weakness can occur, which can be the result of serious and life threatening drug side effects.

Causes

A high level of lactic acid is a known long term side effectAny undesired actions or effects of a drug or treatment. Negative or adverse effects may include headache, nausea, hair loss, skin irritation, or other physical problems. Experimental drugs must be evaluated for both immediate and long-term side effects. of the nucleoside inhibitors. This can result in lactic acidaemia and rarely can cause a severe condition known as lactic acidosis. Higher levels of lactic acid cause muscle inflammation, pain and soreness. These symptoms may also be directly due to the effect of some drugs (e.g. AZT).

Complementary & Supportive Therapy

Therapy: Massage, acupuncture and other forms of physical therapy can be useful. Heat therapies and relaxation therapies may reduce pain in the muscles.

Dietary supplements: Antioxidants such as vitamin C and E, selenium, coenzyme Q10, L-Glutamine, L-Carnitine, N-acetylcysteine (NAC), vitamin B1 (thiamine) and vitamin B2 (riboflavin) may also be of assistance. Vitamin B1 is essential in the formation and maintenance of muscle tissue and assists muscle to make efficient use of carbohydrates for muscle energy. Good food sources of vitamin B1 are whole grains, wholemeal bread, brown rice and pulses.

Diet: Reduce simple carbohydrates and add good sources of magnesium to the diet such as nuts, wheat bran and wheat germ, legumes, beans, bananas, berries, prunes, dried fruits, spinach and brown rice.

Medical & Drug Treatment

Appropriate medications and therapy will depend on the type, intensity, and location of the muscle pain. In severe cases of lactic acidosis where extreme lethargy and shortness of breath prevails, the causative drug will be withdrawn.

Current recommendations for hyperlactatemia and acidosis are to cease HIV antiviral drugs immediately. There is little evidence that coenzyme Q or riboflavin have an effect on reversing lactic acidosis.

Pain relievers such as paracetamol or aspirin may provide temporary relief. Stronger painkillers may be prescribed if needed.

Special Precautions & Considerations

• Lactic acidosis is a potentially life threatening condition. At the first sign of unusual muscle pain, shortness of breath and lethargy, see your doctor. Nucleosides can affect the liverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. resulting in serious lactic acidosis, but this occurs rarely.
• Low-level acidemia and metabolic acidosis (called lactic acidaemia) is more common than lactic acidosis. The symptoms are similar to those of lactic acidosis but they are less severe and are not life threatening. Lactic acidaemia can occur in up to 15% of people taking nucleosides, but protease inhibitors can make this problem worse. Studies suggest d4T may be associated with the greatest risk, but all NRTIs can cause the underlying problem with liver toxicity and inflammation.

Managing side effects