Kidney stones, diarrhea, diabetes, liver toxicity, high triglycerides—and now “protease paunch” (see "A New Kind of Waisting"). The ever-expanding list of protease-inhibitor side effects—piled atop the litany of toxicities from the older antiretrovirals—is a sobering reminder that the widely prescribed cocktails can be a double-edged sword. Yes, these drugs clearly have extended and improved lives. Indeed, death is worse than almost any side effect. But remember that the only evidence of reduced opportunistic infections and deaths comes from people who started the drugs after falling below 200 CD4 cells. Any benefits from earlier use are merely speculative. Taking powerful, toxic drugs without lapses several times daily for the rest of your life is a gigantic risk, that requires full information on possible downsides—often not provided by doctors. With new side effects emerging monthly, and treatment failure mounting, let’s demand that our physicians, hospitals and AIDS organizations present the whole truth to those whose lives are in the balance.
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