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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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brain fog and depression
Oct 13, 2003

I have been on Zerit, Ziagen, and Viramune for 3 yrs. Undetectable, CD4's 530. I started to feel low energy, depressed and "brain fog," affecting my thinking and memory. Liver enzymes are slightly elevated. My doctor and I agreed to a treatment interruption while she checked for lactic acidosis. I came back positive for H. pylori and began antibiotic treatment. Lactic acid level was 1.7. What could it be? and what else should we be looking for?

Response from Dr. Conway

I'm glad the treatment has been working well for you, except for the side effects. The H. pylori is certainly important and needs treatment, but it is NOT the cause of your depression. This is not a common side effect of any of the drugs you are taking, so I would put forward three possibilities:

1. You are simply depressed for another reason (events? the season? just one of those things?) and it will get better, perhaps with the use of antidepressants.

2. There is a physiologic reason for how you feel. Lactic acidosis doesn't seem to be it, but thyroid or adrenal problems (to name but two) can present in this way, and are easy to check for.

3. You are experiencing the cumulative minor side effects of antiviral therapy. This is hard to describe precisely, but it is the feeling that is best appreciated in retrospect by patients who stop HAART and then feel "better", not having realized that they were unwell in the first place!!! So stopping HAART (if you and your doc agree it is safe to do so) may be the best way to address this possibility.

is the use of steroids to treat wasting and weight loss really safe in the long run?
Are meds causing fatigue and drop in HCT?

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