HIV Treatment Side Effects
What are the risks of HIV medications?
The risk of HIV medications depends on which one you're on. The newer medicines have less side effects than the older ones. The side effect profile of antiretral viral therapy has never been terrible. And some of the latest medications that are coming out in clinical trial, so far we haven't even seen any side effects. A couple of medications that are in clinical trials this year and that we hope will be FDA approved this year, such as the CCR5 Inhibitor Maraviroc, and the intergraze inhibitor Raltegravir, so far no side effects have been detected in clinical trials. Of course there's bound to be some side effects in some individuals. But obviously the rate is going to be very, very low, if so far they haven't detected any. And for example the components of Atripla, the side effects are not very frequent with most of the components. Tenofovir very rarely causes any side effect. Very, very rarely it may cause kidney problems, and so that has to be watched. FDC hardly ever causes any side effects in anybody. Sustiva can cause dizziness and funny dreams, and it's not the drug for absolutely everybody. But now we have so many drugs that if a patient has side effects from their first regiment that they are given for their heart treatment, then we can switch them to another one. Which almost certainly won't, but if they're unlucky on the second one we can put them to a third or a fourth. So my goal is to always find a heart regiment that a patient will have no side effects from whatsoever. And that's the case for the majority of my patients. It's a little harder if patients has experienced a lot of drugs and have become resistant to a lot of drugs, and you don't have as many choices. But for patients newly infected who haven't got any resistance, we'll pretty much always find a regiment now that they can take without any side effect.
What are the most common side effects of HIV medications?
Perhaps the most common side effect of HIV medications these days would be actually from Sustiva, because Sustiva is a very commonly used drug. It's part of Atripla, and it can cause weird dreams and dizziness, especially when people start therapy, and it often wears off. Sometimes this HIV medication can make patients irritable or depressed, in which case they should stop taking it. It's a common side effect, but is normally not serious and usually wears off. However, some patients will have to change drugs because they won't tolerate it. Both Sustiva and Viammune can cause rashes, just as almost any drug in the pharmacy can cause a rash, but the incidence of rash with Sustiva and Viamune is about 15%. In some patients, they can go on taking it and the rash will fade away, others will have to stop the drug because of a rash. With Protease inhibitors, the most common side effects are in the gastrointestinal tract, usually meaning loose stools, sometimes frank diarrhoea (although usually not), and maybe some bloating and some feeling of gas. That's very common, but, again, very minor, and less of a problem with the newer HIV medications.
What are the most serious side effects of HIV medication?
The most serious side effects with HIV medications is very rare, and that is lactic acidosis. I have only seen a couple of cases in my life, so it really is very rare. Lactic acidosis means that the body becomes very acidic. The patients get short of breath. The body is very intolerant of high acid levels, and that can lead to death quite quickly. But, thankfully, it's very rare. We do see it overseas a bit, in resource limited settings, where the drugs that we use mostly are indeed AZD 14 DDI, where other drugs are not available in most countries. Other serious side effects, thankfully, are rare. But, if kidney function or liver function is affected, that's bad. Very rarely, with viralkin, the liver can seriously be damaged, very rapidly. If the drug, however, is used only when C4 counts are very low, we've found that doesn't occur hardly at all. But, we do have to warn patients, if they feel sick when they go on those drugs they should let us know quickly. Tenofovir can cause renal damage, but it's very rare. In the clinical trials, they didn't even see it, but we do see it sometimes, but it's slowly developing and reverseable, we just have to watch for it. Sometimes skin rashes can be very severe. Again, it's very rare, but with the virakin and some of the other drugs, a very serious skin rash can occur which can sometimes be fatal. So there are some serious side effects, they don't occur very often, but they do exist.
What's the best way to deal with nausea and vomiting due to HIV medication?
The best way to deal with nausea due to HIV medication is probably to change the HIV medication. It may be OK to put up with nausea for a week or two to see if it wears off, but I always tell my patients nausea is an awful side effect of HIV medication, and you shouldn't have to tolerate that. It's caused by a few HIV medications, and you can switch away. Occasionally you see it with AZT; not very often with any of the other HIV medications.
What are 'body shape changes' that occur with HIV medication?
Body shape changes with HIV medications are what doctors call lipodystrophy, meaning changes in fat concentration on the surface of the body. We talk about llipoatrophy, where there is loss of fat, and that can be seen on the face in the thinning of the cheeks and with loss of fat in the arms and legs where the veins become much more prominent. Or fat deposition, or lipohypertrophy, where people get extra fat around their neck, or the back of the neck or in their belly. We have been noticing these changes for about eight years and it has been a great mystery what causes them for a long time. We definitely know one of the causes. One of the causes seems to be mitochondrial toxicity. Mitochondria are small organelles within cells from the nucleus side group of drugs. With the drugs, probably not from all of them, but from D40, AZT, and DDI. Patients that have received particularly D40 for a long time, have often lost fat in their face and sometime have lipohypertrophy as well. So there are a lot of people who are walking around with lipoatrophy from those drugs, but with starting those drugs more seldom with patients now, so I think we will see less and less body shape changes going forward in patients who are being treated newly and haven't got those changes already.
