Important notice to members of this network on the serious risk to life from the use of antiretrovirals along with treatment for pneumonia.  — Dr. Manuel Garrido Sotelo, Physician

Published by Dr Manuel Garrido Sotelo – 15th April 2012. Translated from the Spanish by Joan Shenton

We do not know how widespread this practice is, or whether it is a new trend, but we certainly know of several cases where people have been treated in a hospital for pneumonia and, along with the appropriate antibiotic treatment for pneumonia, were administered antiretroviral medication (ARV).

I would like to make it clear, in relation to this dangerous practice, that never, to my knowledge, in the 18 years that I have been guiding people in this field, have antiretroviral drugs been administered in the course of treatment for pneumonia. When someone had pneumonia the practice was always to suspend antiviral medication (in the event that the person was taking it), and then to resume it once the pneumonia had been resolved with the appropriate antibiotics or, if the person had not previously been taking antiviral medication, to start it after resolving the pneumonia.

This has always been common practice and it has its reasons:

• Antiretroviral medication, which is made up for the most part by chemotherapy drugs, is immunosuppressive – i.e. it suppresses the immune response – something to be taken into account in the course of an infectious process as serious as pneumonia.
  
  
• Furthermore, antiretroviral medication is highly toxic (cancer chemotherapy drugs are also described in pharmacology as cytotoxic) and when administered in combination with antibiotics, often two or three - depending on the case – the organs responsible for processing this medication – the liver and kidneys – are subjected to excessive stress. Consequently the ability of these organs to remove these drugs from the body is greatly diminished which prolongs the time that the drugs remain in the body, with all the ensuing side effects and toxicity.
  
  
• It is also well known that most ARV drugs act on the mitochondria, organelles that, at the cellular level, are responsible for cellular respiration. This means that if you have an infection in a vital organ such as the lung, which is responsible for breath-oxygenation, its ability to do its job properly becomes impaired at the cellular level, and on top of that you add a drug that further interferes with that cellular respiration.
  
  
• But there's more: As a result of the above, lactic acidosis occurs (a recognized side effect that you see in any report or information about the side effects of many ARVs), and lactic acidosis – which itself causes breathing difficulties, to add to those that have already developed.

Consequences:

It is very easy for a patient to reach such a degree of hypoxia (lack of oxygen), that there is not enough oxygen in the mask which has been applied, and so the person begins to show signs of a deficit of brain oxygenation (numbness, lethargy, coma). Faced with this risk, doctors may decide that they have to intubate. Intubation itself is so unbearable that it requires heavy sedation in order to be able to endure it, which in turn further depresses the respiratory center. This then requires the use of all the paraphernalia and apparatus of an intensive care unit with assisted mechanical ventilation and constant nursing surveillance.

I know of a case of one person from our network of HIV-positive people not taking ARVs, whose detailed medical notes were sent to me more than a year ago. He had been admitted to hospital with pneumonia. Such was the confusion amongst the doctors when they learned he had a low CD4 count but was not taking ARVs that, in the space of a week, they had prescribed no less than 7 antibiotics plus antiretroviral medication. This provoked such respiratory distress that they had to give him positive pressure ventilation. As this was insufficient, they applied more pressure and therefore caused a pneumothorax (air in the chest cavity outside the lung). This in turn caused further respiratory distress, so that they had to intubate. In short, he spent two months barely conscious in the intensive care unit. He survived, helped no doubt by the fact that he was a young person in the prime of life.

Summary:

If at any time you are admitted to hospital with pneumonia, never consent, under any circumstances, to be administered antivirals while you are taking antibiotics for pneumonia. This was avoided in the past and it presents a grave danger. Make sure you warn your family or the people around you about this. If necessary, tell the doctor that you have no objection to taking ARVs when you recover from pneumonia, but strenuously object to them being administered for the simple reason that you could be put at serious risk, a risk that could compromise your life.