Now that antiretroviral therapy is beginning to become available on a large scale, and across a wide range of populations in Africa and Asia, evidence is beginning to emerge about the variations in side-effects and tolerability between different populations.
In particular, side-effects associated with nucleoside analogue treatment, and stavudine (d4T, Zerit) especially, attracted a lot of attention at the Thirteenth Conference on Retroviruses and Opportunistic Infections.
Unfortunately these side-effects have been seized upon in a misleading way by AIDS denialists in South Africa as part of a shameless and highly misleading campaign to derail the roll-out of antiretroviral therapy in a country desperately in need of wider treatment access. AIDS denialists claim that side-effects experienced by people on treatment are a sign that antiretrovirals are `poisoning` South Africans.
"It is really shocking what damage [these] lunatics are doing to HIV care," said Dr Halima Dawood of King Edward's Hospital in Durban. "HIV is a disease that results in death and while the drugs have side effects, we are able to keep patients alive with the drugs."
Indeed, any rational, evidence-based approach to HIV treatment will reject such scare-mongering claims - unfortunately, these tactics do sometimes steer patients away from going on treatment. According to Chris Green, a treatment educator working with the Spiritia Foundation in Jakarta, Indonesia, "the word gets around. In our experience, a number of people who are probably inclined to avoid taking drugs when they feel well decide to delay starting ART because of these concerns."
It is also important to understand that drug toxicity is one of the major obstacles to good adherence, so careful observation of toxicity, education of patients and timely response to their concerns is a necessary part of HIV management.
Toxicities most commonly reported in cohort studies from resource-limited settings presented at the Thirteenth Conference on Retroviruses and Opportunistic Infections included:
 Peripheral neuropathy (damage to the nerves in the feet and legs, caused by d4T, universally reported as the most common serious toxicity)
 Lactic acidosis (a build-up of lactate in the body)
 Rash (caused by nevirapine)
 Anaemia (caused by zidovudine (AZT))
 Lipoatrophy (loss of fat from the limbs and face, chiefly caused by d4T, more prominently a problem in reports from Rwanda and India than from Uganda, South Africa or Kenya)

CD4 cell counts are still increasing after seven years of antiretroviral therapy in patients whose baseline CD4 cell count was below 500 cells/mm3 when they started HIV therapy, delegates to the recent Conference on Opportunistic Infections and Retroviruses (CROI) learnt earlier this month. Other research presented to the conference also showed that, to stand the best chances of achieving an increase in CD4 cell count to normal levels, it is necessary to start treatment with a CD4 cell count above 350 cells/mm3, and that patients with ongoing immune activation and a large thymus have smaller gains in CD4 cell count. A small study in the United Kingdom also suggested a possible role for recombinant human growth hormone to 'kick-start' HIV-specific immune responses.