THE IMPACT OF ETHANOL AND MARINOL MARIJUANA USAGE ON HIV+/AIDS PATIENTS UNDERGOING AZIDOTHYMIDINE, AZIDOTHYMIDINE/DIDEOXYCYTIDINE, OR DIDEOXYINOSINE THERAPY/

Therapeutic observations suggest that azidothymidine (AZT)-resistant H IV+/AIDS patients are frequently offered AZT/dideoxycytidine (DDC) or dideoxyinosine (DDI) therapy The latter therapies have been associated with the development of acute pancreatitis. During the initial portio n of this study, when patients reported limiting ethanol consumption, an increase in CD4(+), a decrease in amylase, and a decrease in lipase was observed in patients on DDI monotherapy. Marinol/marijuana usage was associated with depressed CD4(+) counts and elevated amylase level s within the DDI subgroup. The purpose of this study was to follow the se patients over 1 year and compare clinical indicators of pancreatiti s and HIV progression. After 1 year, the remaining 56 patients were re examined in the follow-up portion for clinical indicators of HIV disea se progression and pancreatoxic/hepatotoxic effects. Those in the AZT group, who remained on this therapy throughout the year, had significa ntly increased amylase values from 55.3 to 69.3 IU/liter (p < 0.05). I n the AZT/DDC group, those who remained on combination therapy through out the year, 4 of the 5 clinical indicators of disease progression ch anged. Amylase, ALT, and AST all increased significantly from 55.2 to 77.8 IU/liter (p < 0.01), from 38.0 to 92.3 IU/liter (p < 0.05), and f rom 55.2 to 97.0 IU/liter (p < 0.05), respectively. Lipase levels decr eased significantly (106.0 to 74.6 IU/liter, p < 0.05). The most remar kable changes occurred in the AZT/DDC group (who reduced ethanol consu mption), wherein clinical indicators of pancreatitis and liver dysfunc tion declined, including amylase (65.0 to 20.0 IU/liter, p < 0.05), AL T (350.0 to 100.0 IU/liter, p < 0.01), and AST (240.0 to 95.0 IU/liter , p < 0.01). No significant changes were noted in the DDI or AZT group s. Marinol/marijuana use was associated with declining health status i n both the AZT and AZT/DDC groups. In contrast, all clinical indicator s of pancreatitis improved in the DDI patients who utilized Marinol/ma rijuana, including amylase (-34%), lipase (-30.8%), ALT (-21.4%), and AST (-20.1%). This paired follow-up study suggests that HIV+/AIDS pati ents on antiretroviral therapies should restrict their ethanol consump tion. In HIV+/AIDS patients with the lowest CD4(+) counts (those on DD I monotherapy), utilization of Marinol/marijuana does not seem to have a deleterious impact.