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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
           
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Side Effects Of HIV and Meds
Feb 28, 2011

I just read a couple questions to you and I wanted to follow up.

One person asked you what happens when you're not on HAART. Of course, most everyone will progress to AIDS without meds. You mentioned damage to organs like the kidneys and liver. I was wondering what you think or what you have observed in your own patients who are putting off meds, because they have good or decent numbers. I'm in that category. I believe I have been infected for going on 10 years, but only found out 2 years ago. My CD4 stays around 700 and vl around 11,000. Do you think we are at higher risk of developing organ damage from untreated HIV? If so, is the damage more than the what the meds may cause themselves?

Someone else asked you why HIV meds are so toxic. I've wondered about this myself. We hear constantly how toxic these meds may be. Are they really any more toxic than other meds, such as Lipitor, depression meds, etc? When you watch commercials for those meds, they list scary side-effects, but usually only happen to a minority. Have HIV meds gotten a bad wrap, or is there really something different about them that makes them more toxic?

Response from Dr. Henry

The toxicity of currently recommended regimens used in the US is low overall. Serious toxicity still occurs but < 5% rate in my experience and can be picked up with clinical and lab monitoring. Much of the bad karma about side effects is a carry over from years past when the meds were indeed more toxic and complicated. There is still room for improvement but most often a well tolerated regimen can be found for most patients in resource rich countries with a variety of drugs available. The clinical benefit of treatment for patients with CD4 count > 500 is likely modest (serious event rate may be in range of 1-5%/year). The START Study now enrolling in US and many international sites is attempting to more precisely determine what the benefit is when treating at high CD4 counts. I encourage HIV+ untreated readers to fin dout more about the START Study, There likely is a public health benefit to treating early with decreased risk for transmission which weighs in on the cost benefit analysis. KH



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