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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Mar 16, 2007

I was diagnosed sleep apnea in 2005 having been positive for 6 years and on ARV for 3 years then. I had tonsillectomy in May 2006. In the course of this time I have changed my drug regime twice. First was from Stocrin to Nevirapine because of the depression side effect. The second was from Stavudine to AZT (Zidovudine) because of my lipoatrophy. I am presently on the combo of AZT+3TC+Nevirapine. I recently gained more weight from 65kg to 72kg. I used to weigh 75kg pre-ARV.

After my tonsillectomy in 2006 I still experience snoring and daytime somnolence, which is adversely affecting my study. So I had to go back to ENT for consultation. I was sent for polysomnogram (sleep test) on the 22nd of last month and booked for special clinic yesterday (Wednesday).

On my first special clinic just after my tonsillectomy, I was told by the leading specialist, a professor, that my sleep apnea has nothing to do with my HIV. But on my second special clinic and after conducting endoscopic examination on me, I was now informed that the sleep apnea has co-morbidity with my HIV. The exam showed that I have enlarged lymphoid tissue and prominent base of tongue as a result of enlarged lingua tonsil.

Before now, the specialist was contemplating surgery as a last resort but after this examination, the panel of special clinic consisting of two professors, a specialist and several ENT doctors concluded that surgery is not an option and believe that my sleep apnea is due to co-morbidity. The only option, I was advised, is to obtain CPAP.

My concerns are first, I was informed that CPAP is not a permanent solution to sleep apnea; second, if my sleep apnea is left untreated what effect can it have on the progression of my HIV? Or on its own if left untreated what is the worst scenario?

I sleep most during the day with my study suffering in the process. And Im writing semester exam in May in my second year towards LLB.

Response from Dr. Henry

Some HIV+ persons who are doing well can have persistent enlarged lymphoid tissue including in the oral cavity. Sleep apnea can be a challenging disorder for which CPAP can provide symptomatic improvement and for which surgery is not always the best option depending on the anatomic situation. I have had scores of patients with HIV and sleep apnea. Since sleep apnea and HIV are fairly common they can co-exist in the same patient so it is unclear to me if HIV+ persons are at higher risk for sleep apnea. With markedly improved long term survival and frequent weight gain as a problem in HIV+ persons on effective treatment, it seems like the opportunity to observe increased rates of sleep apnea is there and I believe that I have seen that in my own patients. What I don't know is whether increased size of oral lymphoid tissues contributes more to the problem among HIV+ persons. That is an interesting concept but again I haven't seen much on that from studies of HIV+ populations. Most of my patients with sleep apnea seem to respond to standard treatment approaches similarly to non-HIV+ persons from what I have observed and the feedback I get from our sleep clinic specialists.KH

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