Guarding against unwanted reactions

The side effects of today’s HIV treatments are not as common or severe as those suffered by many people in the late 90s. If you’re starting out on treatment now, you’re also unlikely to experience lipodystrophy, thanks to greater knowledge and better risk management. Almost any drug you take can cause the unwanted responses to medication known as side effects. These take two forms – effects caused directly by the drug (which are usually short-term), and allergic reactions (sometimes called allergic side-effects).

With some long-term use of some anti-HIV drugs, sometimes there’s also a build-up of toxicities (harmful effects) that can lead to problems like diabetes, increased risk of heart disease, and lipodystrophy (fat loss and accumulation). Siince combination therapy was introduced in the mid 90’s, a lot has been learned about these potential adverse effects. Now, guidelines for starting treatment take possible toxicities into account, so they can be weighed against the drugs’ benefits.

Medical practitioners are now also far better able to take action before toxicities turn into serious issues. A range of blood tests will be conducted before you start any drug combination, and then at regular intervals. This will alert you and your doctor to any changes in your blood counts that might indicate the development of toxicities.

Currently, the major concerns about toxicity and HIV drugs are their possible role in the development of lipodystrophy, hepatotoxicity (liver problems), nephrotoxicity (kidney problems), bone disorders, hyperglycemia (insulin resistance and diabetes), and dyslipidemia (abnormally elevated triglycerides and cholesterol) that could lead to heart disease.

Common side effects

When you start antiretroviral treatment, you may get headaches, hypertension or a general sense of feeling ill. These usually improve and should disappear over time.

Fatigue
Most people with HIV feel tired at least part of the time. It's important to find the cause of fatigue and deal with it. Anaemia can cause fatigue. Anaemia increases your risk of getting sicker with HIV infection. Routine blood tests can detect anaemia and it can be treated.

Digestive Problems
Many drugs can cause nausea, vomiting, gas or diarrhoea. In most cases this will cease or decrease over time. Ways to offset digestive problems include:

• Instead of three big meals, eat small amounts, more often
• Eat food and soups which are not too spicy
• Drinking ginger ale or ginger tea to settle nausea

Don't skip meals or lose too much weight. Avoiding foods like beans, some raw vegetables and vegetable skins can reduce gas and bloating. Diarrhoea can range from a small hassle to a serious condition. Tell your doctor if diarrhoea goes on too long or if it's serious.

Skin Problems
Some medications cause rashes. Most are temporary but in rare cases they indicate a serious reaction. Talk to your doctor if you have a rash. Other skin problems include dry skin or hair loss. Ways to offset skin problems include:

• Moisturising to help some skin problems
• Drinking plenty of water
• Avoiding harsh soaps and perfumes
• Taking supplements of zinc, vitamin A or B6

Possible long term side effects

Lipodystrophy
This includes fat loss in arms, legs and face; fat gain in the stomach or behind the neck and increases in fats and sugar in the blood. These changes may increase the risk of heart attack or stroke. Ways to offset lipodystrophy include:

• Diet and exercise (helps improve overall wellbeing)
• Cosmetic procedures (e.g. Newfill, Sculptra)
• Changing medications (discuss with your GP first)

Neuropathy
This is a painful condition caused by nerve damage. It normally starts in the feet or hands. Ways to offset neuropathy include:

• Acupuncture
• Massage
• Pain relievers
• Supplements of vitamins B12 or L-carnitine
• Changing medication (discuss with your GP first)

Bone Problems
Bone problems have recently been identified in people with HIV. Bones can lose their mineral content and become brittle. A loss of blood supply can cause hip problems. Ways to offset bone problems include:

• Exercise
• Calcium supplements

Cardiovascular Disease
Recently, more incidences of cardiovascular problems have been seen in people with HIV. Some treatments can raise cholesterol levels as well as lipid levels which can have an adverse affect on the heart. Ways to offset cardiovascular disease include:

• Changes to diet
• Exercise
• Stopping smoking
• Changing medications (consult with your doctor first)

Mitochondrial Toxicity
This is damage to structures inside the cells. It might cause neuropathy, kidney damage, and can cause a build-up of lactic acid in the body. Talk to your GP about changing medications if this occurs.

Dealing with side effects

There are several steps you can take to prepare yourself to deal with side effects.

• Learn about the possible side effects for the medications you're taking
• Talk to your doctor about what side effects to expect and ask when you should get medical attention if a side effect goes on too long or has become severe
• Find out if you can treat mild side effects with over-the-counter medications
• In some cases, your doctor can write you a prescription for something you can take to deal with a side effect if it becomes severe
• Don't stop taking any of your medications, or skip or reduce your dose, without talking to your doctor - doing so can allow HIV to develop resistance and you might lose the use of some antiretroviral drugs. 

The bottom line

Most people who take antiretrovirals have some side effects. However, don't assume you'll get every side effect you hear about. Get information on the most common side effects and how to treat them and find out ways that you can help offset possible side effects. Consult your doctor if a side effect may have gone on too long or become severe. Don't let side effects keep you from taking your medications. If you can't deal with them, talk to your doctor about your options.

More info

Contact: ACON’s HIV Men's Health Promotion Team or ACON's Women & Families Project

Tel: (02) 9699 8756

Email: hivliving@acon.org.au or family@acon.org.au