Side Effects of HIV Antiretroviral Drugs and How to Manage Them

The aim of the medications given in the treatment of HIV and AIDS is mainly to treat the HIV disease. The second priority is to keep the person comfortable not just physically, but also psychologically.

Psychological comfort is given by counseling and physical comfort is given by ART drugs with the least negative side effects.

All HIV/AIDS drugs exhibit side effects. They can be short-term or long-term; they can be mild or severe. Management can be done and is often done, effectively.

There are now more than 20 anti-HIV drugs available, and your doctor can often change to a drug that doesn’t cause the side-effect.

Most side effects are physical, but some anti-HIV drugs can affect your emotional and mental health.

Side effects of HIV/AIDS medication, whether short-term or long-term, if any, should be dealt with by the treating doctor.

Each drug of each class of antiretroviral therapy has different side effects and rarely they can be serious.

They have to be closely monitored by yourself and your physician. Nothing would please the patient more than to have the least physical discomfort while having to live with a mental state of despair. These patients are in a constant fear of death due to their HIV infection.

It is important for an HIV patient to discuss his/her medical history with the doctor including the taking of over the counter medications.

This will help your doctor to prescribe or change medications so that the least side effects are experienced and interactions between the medications are avoided.

Common short-term side effects of HIV medications

Broadly, these side effects, which are common and last for a short time include:

  • Headaches
  • Nausea
  • Vomiting and diarrhea
  • Skin rash can be due to the HIV infection or the effects of the ART medicines. It goes away in several days or weeks without treatment. Sometimes, it may be necessary to change to another HIV medicine.
  • Shortness of breath
  • Anemia
  • Dizziness

However, these side effects tend to disappear within a few weeks in most cases. Till then, one must learn to cope with them and take symptomatic treatment, if necessary.

Severe and long term side effects of HIV medication

Long term side effects of HIV medications tend to be of a severe type, can last for a longer period and some of them can be quite serious. If you observe any of the effects mentioned below, you must inform your doctor.  Looking out for these side effects during follow up visits to your doctor forms part of HIV treatment care.

1) Changes in body fat distribution (Lipodystrophy)

Lipodystrophy occurs when there are changes in the production, mode of use and storage of body fat. There is loss of fat from some parts of the body and extra deposition in other parts. There is loss of peripheral fat and accumulation of central fat.

Typically, you will see the loss of fat from the face, arms, legs, and the buttocks. The fat buildup is seen on the back of neck and shoulders, breasts and abdomen. Localized fatty deposits in different areas of the body called lipomas may also be seen.

Please note that HIV itself without medicines can cause lipodystrophy. Fat loss is also caused by the wasting syndrome, which is a complication of AIDS.

HIV drugs that cause lipodystrophy

Newer drugs have fewer incidences of these, but these side effects are seen with the older versions of protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs).

How to deal with lipodystrophy

There are three things one can do if lipodystrophy occurs.

  • Exercise to get rid of the extra fat. These exercises should be aimed particularly at the areas where the extra fat deposition has occurred. This will help build muscle and lose the extra deposited fat.
  • Eat a healthy low-fat diet.
  • Most importantly consult your doctor. He may advise change in HIV medicines. Newer medicines have a lesser incidence of lipodystrophy.
  • Your doctor may also advise tesamorelin (Egrifta), a new drug in the market for lipodystrophy. It helps to reduce belly fat.

 

2) Elevated blood sugar levels (hyperglycemia) due to insulin resistance

In the 1990s, when antiretroviral drugs were introduced, there was a significant increase in the insulin resistance and diabetes (hyperglycemia) cases among the HIV positive people on ART

High blood sugar leading to diabetes can be another side effect of HIV medication. Symptoms of weight loss, increased frequency of urination and excessive thirst can be the symptoms.

HIV drugs causing insulin resistance

Protease inhibitors (PIs) were mainly responsible for this side effect then. Newer medications of PIs, however, have a significant reduction in the incidence of this side effect.

How to cope with insulin resistance

If you were diabetic when you caught the HIV infection, you should very closely interact with your doctor and monitor your blood sugar regularly. In such cases, the risk of a heart disease increases many folds.

Insulin resistance due to HIV medication should be dealt with by following your doctor’s advice.

Lifestyle changes, which include a healthy diabetic diet, regular exercise, and cessation of smoking, should be at the top of your agenda.

Alcohol, without saying, is prohibited in HIV positive patients. Your doctor will give you the necessary medicines to deal with the increased blood sugar and may change your HIV medicines.

3) Bone loss or decrease in bone density

Loss of bone density increases the risk of bone injuries and fractures. Bone loss is observed more in the hip and spinal regions.

Bone loss can be a significant issue in older patients who are on ART, where there is already a natural loss of bone density due to age.

Other risk factors that can increase the chances of loss of bone density include: belonging to the female gender, advanced age, alcohol, smoking, obesity and a sedentary lifestyle. Complications include osteoporosis, osteopenia, and osteonecrosis.

HIV medicines causing loss of bone density

Bone loss is attributed to NRTIs and NNRTIs class of HIV medicines.

How to deal with bone loss due to HIV medication?

  • Calcium and vitamin D supplements
  • Exercises such as walking and weight lifting (In younger patients)
  • Healthy diet especially rich in calcium and vitamin D
  • Your doctor may prescribe medicines for or to prevent osteoporosis

4) Increased lipid blood levels

Some HIV medications increase levels of cholesterol and triglycerides in the blood. This increases the risk of heart attack and therefore, close monitoring of lipid blood levels is necessary when on HIV therapy.

HIV medicines causing abnormal lipid levels

Protease inhibitors (PIs) are most responsible for this abnormal lipid level side effect. However, not all PIs cause this abnormality.

For example, atazanavir, a protease inhibitor, does not cause changes in lipid blood levels. Other classes of HAART, which can cause this abnormality are NNRTIs.

How to deal with lipid abnormalities

  • Maintain healthy weight
  • Healthy low-fat diet
  • Regular exercise
  • Regular testing of lipid profile
  • Your doctor may prescribe statins and fibrates if necessary, for the high cholesterol and triglyceride levels

5) Lactic acidosis and liver damage

Lactic acid is a byproduct waste of the energy producing process from glucose and fat by the body cells. The body cells contain mitochondria, which form a power plant that produces this energy and the byproduct, lactic acid.

Damage to the mitochondria results in a buildup of the waste, lactic acid. An increase in lactic acid levels is called lactic acidosis. This can be a life threatening condition and is a rare complication of HIV medicines.

Symptoms include muscle aches, vomiting, persistent stomach pain and shortness of breath. Liver damage is a complication of lactic acidosis.

HIV medicines causing lactic acidosis

Nucleoside reverse transcriptase inhibitors (NRTIs) cause hyperlactatemia by disrupting the function of the mitochondria.

In particular, Zerit (stavudine) and Videx (didanosine) are more responsible for causing this side effect.

How to cope with lactic acidosis

Lactic acidosis is a serious condition. The best thing to do if you experience its symptoms is to contact your doctor.

Whatever the side effects of the HIV/AIDS treatment and its medications, consult your doctor. He/she will find ways to go around them. The important thing is not to stop the antiretroviral therapy. The dangers of doing this will be more severe.

Psychiatric side effects

Some anti-HIV drugs can disturb you emotionally and mentally. Most notably, the non-nucleoside reverse transcriptase inhibitor (NNRTI) efavirenz (Sustiva, also in the combination pill, Atripla) has been linked with depression and sleeplessness, as well as dramatic dreams.

People with a previous history of mental problems should inform their doctor because then, efavirenz might not be a good choice of drug for you.

However, this mental side effect of the anti-HIV drugs might disappear after a few weeks of starting the treatment. But, in some, it may persist.

Management of this side effect is done by lowering the dose of the drug or changing to an another drug. As mentioned above, the choice is wide.

 

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