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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
           
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Avoiding side effects
Jun 18, 2003

Hi.

This might be a hard question, but...What do you think is the best combo to start on in order to avoid side effects?

My partner was just diagnosed. I have been positive for six years. I don't want him to go through the same thing I went through.

Thanks.

Response from Dr. Conway

This is a difficult question. We have not yet designed any drug or combination that is completely free of side effects. No regimen is perfect!!!

You and your partner could begin by deciding which short term side efects you most want to avoid. Is it diarrhea? Liver PROBLEMS? A skin rash? Maybe for you, bad dreams would be a disaster? Or maybe it's severe vomiting or neuropathy? Armed with this information, you should pick the drugs that best fit the profile that you will be able to "live with", understanding that if any side effect develops, there is likely a way to control it, even if it means having to change the drugs in your regimen.

Then there are the long-term side effects, such as changes in your cholesterol, blood sugar, and changes in your body, with loss or accumulation of fat. There is no way of being sure this will never happen, but the regimens that are most associated with this are those including protease inhibitors or the combination of didanosine and stavudine.

When all is said and done, there are many choices avaiable to you. The best choice is the one that you will take with confidence, as adherence to therapy is the best way of ensuring its success. And you won't take it if you aren't totally "buying into it"!!!!

Good luck in making this important decision.

Response from Dr. Young

I'd echo Dr. Conway's answer, in that the best way to answer is to ask yourself (or your partner) what are the side effects that you'd like the most to avoid, the ones that might be more acceptable or manageable. There are also some medical conditions (like hepatitis or heart disease) that might also limit some treatment options.

Newer treatment regimens that include two NRTIs and an NNRTI (like efavirenz or nevirapine) are currently considered to be state of the art; with very low pill counts, excellent long-term safety and efficacy and can be extrememly well tolerated. If everything else is equal, we've been using this approach for a number of patients with excellent results.

The key issue with starting any drug regimen is to work on adherence and communications with your healthcare provider. We have gained considerable "wisdom" about how to manage or prevent minor side effects. Additionally, since we are fortunate to have a number of options to start with, unacceptable side effects can often be dealt with simply by switching medications.

Buenos suerte- BY



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