During the treatment, the peripheral blood pattern is monitored: 1 every 2 weeks for the first 3 months of therapy, then 1 time per month. Hematologic changes appear 4-6 weeks after initiation of therapy: anemia and neutropenia develop more often in patients receiving large doses, with HIV infection (with reduced bone marrow reserve before therapy), neutropenia, anemia, vitamin B12 deficiency. With a decrease in hemoglobin content by more than 25% or a decrease in the number of neutrophils by more than 50% compared to the baseline - control of blood tests is performed more often.
During the period of treatment, it is necessary to monitor the activity of alanine aminotransferase, aspartate aminotransferase, amylase, lipase, serum thyroglobulin concentration.
In patients with impaired renal function, control of the concentration of urea nitrogen, creatinine in the blood serum is necessary.
In patients on the background of therapy, opportunistic infections and other complications of HIV infection can develop, so they should remain under the supervision of doctors. Antiretroviral therapy does not prevent the transmission of HIV through sexual contact and through infected blood.
If resistance to lamivudine occurs, zidovudine-resistant strains may again appear susceptible to zidovudine.
There are rare reports of the development of pancreatitis in patients taking lamivudine. It is not established whether pancreatitis is an adverse drug reaction or a complication of HIV infection. And, nevertheless, with the appearance of clinical or laboratory signs indicating the development of pancreatitis, lamivudine should be discontinued.
Lactacidosis / Hepatomegaly with steatosis
With the use of nucleoside analogs, including lamivudine, monotherapy or in conjunction with other antiretroviral drugs may develop lactic acidosis, a marked increase in the liver with steatosis, including fatal. Risk factors are obesity, prolonged use of nucleosides, female sex.If the patient has clinical or laboratory signs of lactic acidosis or hepatotoxicity, even if there is no significant increase in the level of transaminases, the drug should be stopped.
Redistribution of adipose tissue
In patients receiving antiretroviral therapy, redistribution / accumulation of adipose tissue of the body was observed, including abdominal obesity, dorsocervical fat deposition ("buffalo hump"), lipoatrophy on the limbs and face, breast enlargement and "cushingoid" type of obesity. The mechanism of occurrence and long-term effects are not known. The causal relationship with taking ARV drugs has not been proven.
It should also be noted that lipodystrophy syndrome has a multifactorial etiology; for example, the stage of HIV infection, old age, duration of antiretroviral therapy, may be synergistic risk factors.
Exacerbation of hepatitis B y patients with co-infection with the hepatitis B virus
In HIV-infected patients with co-infection with the hepatitis B virus, lamivudine can be reversed to cause a lightning-fast exacerbation of hepatitis with an increase in the level of hepatitis B virus DNA and an increase in alanine aminotransferase activity,therefore it is necessary to carefully monitor the liver function indices and be cautious about the clinical manifestations of hepatitis within a few months after discontinuation of lamivudine. Syndrome of reactivation of the immune system and the development of resistance to hepatitis B virus can also cause exacerbation of hepatitis B.
Preventive (proactive) therapy
Urgent, within 1-2 hours after a suspicious contact (with an HIV-infected person or infected material), combination therapy with lamivudine and retrovir should be prescribed. In the case of a high risk of infection, a drug from the protease inhibitor group should be included in the treatment regimen. Preventive therapy is carried out for 4 weeks.