Question

A patient with HIV-associated dementia receiving antiretroviral therapy presents with a burning sensation in feet and hands, numbness and tingling in the feet, cramps in the legs, and absent ankle reflexes. What drug will you be the LEAST likely to blame on his/her new symptoms? a. Zidovudine b. Stavudine c. Didanosine d. Zalcitabine e. All of the above can cause the patient's symptoms

Short answer

a. Zidovudine b. Stavudine c. Didanosine d. Zalcitabine Answer: a. Zidovudine

Step-by-step solution

Research side effects of each drug

To determine which drug is the least likely to cause the patient's symptoms, we need to research the side effects of each drug and see which ones are known to cause peripheral neuropathy or similar symptoms.

Identify which drugs cause peripheral neuropathy

After researching the side effects of each drug, we find that: - Zidovudine (AZT) can cause side effects such as fatigue, nausea, and headache, but it is not commonly associated with peripheral neuropathy. - Stavudine (d4T) can cause peripheral neuropathy, as well as other side effects such as pancreatitis, lipodystrophy, and lactic acidosis. - Didanosine (ddI) is also known to cause peripheral neuropathy, along with other side effects such as pancreatitis, hepatotoxicity, and lactic acidosis. - Zalcitabine (ddC) has peripheral neuropathy as one of its most common side effects, along with other side effects such as mouth ulcers, diarrhea, and rash.

Select the drug least likely to cause the patient's symptoms

Based on our research on the side effects of each drug, we can see that Zidovudine (a) is the least likely to cause the patient's peripheral neuropathy symptoms. Although all these drugs may have side effects, Zidovudine is not commonly associated with peripheral neuropathy, unlike the other options. Therefore, the correct answer is: a. Zidovudine

Key concepts

HIV-associated Dementia

HIV-associated dementia (HAD), also referred to as AIDS dementia complex, is a cognitive impairment syndrome that can oftentimes be seen in advanced stages of HIV infection. It results from the direct effects of the HIV virus on the brain and the immune system's response to the infection. Symptoms can range from memory loss, concentration difficulties, and even motor coordination problems.

Advanced antiretroviral therapy (ART) has significantly reduced the prevalence of HAD by effectively controlling the replication of the HIV virus. However, patients on ART may still experience cognitive issues, although generally less severe than those seen in HAD. These could be due to the virus itself or as a side effect of prolonged ART use. Therefore, continuous monitoring of cognitive function is essential for those undergoing treatment for HIV.

Antiretroviral Side Effects

Antiretroviral therapy has revolutionized the management of HIV, turning what was once a fatal prognosis into a manageable chronic condition. However, these medications come with a trade-off in the form of side effects. While these can vary depending on the specific drug and regimen, common antiretroviral side effects include gastrointestinal issues such as nausea and diarrhea, metabolic changes like lipodystrophy, and more general symptoms such as fatigue and headaches.

Moreover, long-term use of antiretrovirals can also lead to more severe issues like cardiovascular disease, kidney and liver damage, and bone density loss. Patients experiencing side effects should discuss them with their healthcare provider, as there are often ways to manage these symptoms or alternative treatment options available.

Neurological Side Effects of HIV Treatment

Neurological complications are among the most challenging side effects of HIV treatment. Medications that effectively suppress the virus can, ironically, also affect the nervous system. Peripheral neuropathy, as reflected in the exercise, is a known neurological complication, presenting as a burning sensation, numbness, and tingling, usually in the hands and feet. It's caused by damage to the peripheral nerves and can be a direct effect of certain antiretroviral drugs.

Of the antiretrovirals listed in the exercise, Zidovudine may be the least likely to cause peripheral neuropathy, unlike Stavudine, Didanosine, and Zalcitabine. Besides neuropathy, other neurological side effects may include mood changes, cognitive impairment, and sometimes, more rarely, seizures. Patients should report any new or worsening symptoms to their healthcare provider to ensure proper management and care.