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The Impact of Ethanol and Marinol/Marijuana Usage on HIV+/AIDS Patients Undergoing Azidothymidine, Azidothymidine/Dideoxycytidine, or Dideoxyinosine Therapy
Author(s) -
Whitfield Robert M.,
Bechtel Lisa M.,
Starich Gale Hansen
Publication year - 1997
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/j.1530-0277.1997.tb03739.x
Subject(s) - didanosine , zalcitabine , medicine , liter , gastroenterology , zidovudine , pancreatitis , acute pancreatitis , human immunodeficiency virus (hiv) , immunology , viral disease
Therapeutic observations suggest that azidothymidine (AZT)‐resis‐tant HIV+/AIDS patients are frequently offered AZT/dideoxycytidine (DDC) or dideoxyinosine (DDI) therapy. The latter therapies have been associated with the development of acute pancreatitis. During the initial portion of this study, when patients reported limiting ethanol consumption, an increase in CD4 + , a decrease in amylase, and a decrease in lipase was observed in patients on DDI monotherapy. Marinol/marijuana usage was associated with depressed CD4 + counts and elevated amylase levels within the DDI subgroup. The purpose of this study was to follow these patients over 1 year and compare clinical indicators of pancreatitis and HIV progression. After 1 year, the remaining 56 patients were reexamined in the fob low‐up portion for clinical indicators of HIV disease progression and pancreatoxic/hepatotoxic effects. Those in the AZT group, who remained on this therapy throughout the year, had significantly increased amylase values from 55.3 to 69.3 IU/liter ( p < 0.05). In the AZT/DDC group, those who remained on combination therapy throughout the year, 4 of the 5 clinical indicators of disease progression changed. Amylase, ALT, and AST all increased significantly from 55.2 to 77.8 IU/liter (p < 0.01), from 38.0 to 92.3 IU/liter ( p < 0.05), and from 55.2 to 97.0 IU/liter ( p < 0.05), respectively. Lipase levels decreased significantly (106.0 to 74.6 IU/liter, p < 0.05). The most remarkable changes occurred in the AZT/DDC group (who reduced ethanol consumption), wherein clinical indicators of pancreatiiis and liver dysfunction declined, including amylase (65.0 to 20.0 IU/liter, p < 0.05), ALT (350.0 to 100.0 IU/liter, p < 0.01), and AST (240.0 to 95.0 IUhter, p < 0.01). No significant changes were noted in the DDI or AIT groups. Marinollmarijuana use was associated with declining health status in both the AZT and AZT/DDC groups. In contrast, all clinical indicators of pancreatitis improved in the DDI patients who utilized MarinoVmarijuana, including amylase (‐34%), lipase (‐30.8%), ALT (‐21.4%), and AST (‐20.1%). This paired follow‐up study suggests that HRI+/AIDS patients on antiretroviral therapies should restrict their ethanol consumption. In HIV+/AIDS patients with the lowest CD4 + counts (those on DDI monotherapy), utilization of MarinoVmarijuana does not seem to have a deleterious impact.