Side Effects of HIV Treatment

I am a little confused this week. Some of us are posting about prevention and some about side effects of treatment. But here I go with...

 

Side Effects of HIV Treatment

The NIH has a handy booklet detailing the major side effects of HIV medications. I’ll address only those medications recommended by WHO in this post.

As a refresher, the WHO medications are four nucleoside reverse transcriptase inhibitors (emtricitabine, lamivudine, tenofovir, and zidovudine) and two non-nucleoside reverse transcriptase inhibitors (efavirenz and nevirapine).

Hepatotoxicity (includes hepatitis, hepatic necrosis, and hepatic steatosis)

Signs and Symptoms

·       Elevated liver enzymes (ALT, AST, GGT)

·       Nausea/vomiting

·       Abdominal pain

·       Loss of appetite

·       Diarrhea

·       Feeling tired or weak

·       Jaundice

·       Hepatomegaly

Implicated Meds

NRTIs and NNRTIs (i.e., all WHO-recommended meds)

Likely Treatment

Stop or change meds

Lactic Acidosis

Signs and Symptoms

·       Low blood pH

·       Persistent nausea, vomiting, and abdominal pain

·       Unexplained tiredness

·       Shortness of breath

·       Rapid breathing

·       Enlarged or tender liver

·       Cold or blue hands or feet

·       Abnormal heartbeat

·       Weight loss

Implicated Meds

NRTIs, although the two prime suspects (stavudine and didanosine) are not on WHO’s list.

Likely Treatment

Medical emergency, likely hospitalization with IV fluids and potential respiratory support. Stop meds.

Lipodystrophy

Signs and Symptoms

·       Maldistribution of fat

·       Accumulation (buffalo hump, potbelly, breasts, lipomas)

·       Loss (face, arms/legs, buttocks)

Implicated meds

NRTIs, NNRTIs, with stavudine the prime suspect (not on WHO’s list).

Likely Treatment

Med change, diet/exercise to build muscle and reduce fat

Skin Rash

Emergency Signs and Symptoms of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)

·       Red spots with blisters in the center

·       Blisters in moist areas of body

·       Peeling skin leaving painful sores

·       Fever

·       Headache

·       General feeling of illness

Implicated meds

NRTIs, NNRTIs. Nevirapine (WHO) and abacavir (not WHO) most often implicated.

Likely Treatment, Mild

Med change, antihistamine.

Likely Treatment, Severe

Emergency. Hospitalization, likely in a burn unit.

The booklet also mentions three side effects which are associated only with protease inhibitors (which are not recommended by WHO): hyperglycemia, hyperlipidemia, and bone disorders (osteonecrosis, osteopenia, and osteoporosis).

References

U.S. Department of Health and Human Services (2005). Side effects of anti-HIV medications. Retrieved November 2011 from: http://www.aidsinfo.nih.gov/ContentFiles/SideEffectAnitHIVMeds_cbrochure_en.pdf

If, like me, you find the alphabet soup of generic names, brand names, and combination drugs mystifying, the FDA has a terrific chart that breaks it all down:

http://www.fda.gov/ForConsumers/byAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm118915.htm