Medications

Nutrients and nutritional status of the HIV-infected individual can affect the absorption, use, elimination, and tolerance of antiretroviral medications [71-73]. Treatment of HIV-infected pregnant women is based on the premise that therapies of known benefit to women should not be withheld during pregnancy unless they have known adverse effects on the mother, the fetus, or the infant, and unless the adverse effects outweigh the benefit to the woman [74]. While some antriretroviral mediations are well tolerated, others have potential nutritional side effects. Zidovudine, a nucleoside reverse transcriptase inhibitor (NRTI) that is approved by the US Food and Drug Administration (FDA) for use during pregnancy to prevent vertical transmission of HIV to the newborn is associated with nausea and vomiting, as well as bone marrow suppression that may increase the severity of anemia [16, 23, 75]. Ritonavir, a protease inhibitor (PI) is also associated with gastrointestinal upset, while Indinavir, another PI is associated with hyperbilirubinemia, which is a concern for the newborn [76]. Timing of antiretroviral (ARV) medications with regard to meals is important in terms of medication efficacy and managing drug-related side effects. Indinavir should be taken 1 h before or 2 h after meals [77], but can be taken with light, low-fat meals if necessary. Ritonavir should be taken with food and liquids such as, chocolate milk, to lessen the bitter aftertaste [78] (See Table 12.3).

A phenomenon of fat redistribution, or lipodystrophy, is often seen in HIV-infected individuals on ARV therapy, specifically PI, NRTI, or both [79, 80]. This usually occurs as a result of long-term ARV therapy. The syndrome is characterized by loss of subcutaneous fat from the face, arms, and legs and oftentimes deposition of excess fat in the neck, upper back, and the trunk [79]. Additionally, metabolic complications such as insulin resistance, hypertriglyceridemia, low levels of serum low density lipoprotein cholesterol, and hyperglycemia are commonly seen.

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