Each antiretroviral medication comes with its own side effects, and a triple combination regimen can pack a punch. As people with HIV live longer on therapy, it is crucial to address side effects appropriately. Side effect management can improve quality of life and can increase the duration of treatment with a specific regimen. At the April community forum, three knowledgeable speakers presented information on side effects and offered advice from their own practices on how to tackle side effects head on.
DSP may be a direct effect of HIV infection or the condition may be caused by antiretroviral treatment. The "d" drugs -- d4T (Zerit), ddI (Videx) and ddC (Hivid) -- are most often the culprits in treatment-related DSP. In severe cases of DSP, these medications may need to be discontinued. There may be advantages to staying on the "d" drugs and treating DSP, however. Dr. Geraci described studies showing a relationship between elevated viral load and increased incidence of DSP. So even though the "d" drugs may cause DSP, they can also help keep viral load low. The decision whether or not to stay on "d" drugs must be considered on a case-by-case basis.
Dr. Patrick Dalton described the symptoms of lactic acidosis -- nausea, lack of appetite, malaise (general poor feeling), weight loss, and dyspnea (difficulty breathing). Several lab tests, including a test for the level of lactic acid in the blood, can be performed to verify the condition. Individuals with lactic acidosis may have to discontinue their "d" drugs and switch to other nucleoside analogs like AZT (Retrovir), 3TC (Epivir), or abacavir (Ziagen). The high acid levels can be corrected using sodium bicarbonate or dichloroacetate. If lactic acidosis goes untreated, it may cause organ failure, and there is a high risk of death. In fact, 20 of the 107 cases of lactic acidosis reported to the FDA before June 1998 were fatal. Interestingly, the condition is more common in women than in men. Obese women are at highest risk for developing lactic acidosis.
One potential preventive measure is taking supplements of coenzyme Q, riboflavin, thiamine, or L-carnitine. These supplements assist in cellular energy production. Always talk with your doctor before starting any new treatments. Dr. Dalton concluded by stating that the lactic acidosis can be life-threatening but is fairly uncommon, but that an awareness of the signs and symptoms of the condition helps doctors and patients recognize and address lactic acidosis in a timely manner.
Protease inhibitors brought not only better health but also surges in cholesterol levels, first back to normal, then to way above normal. And Ms. Tinnerello's advice has changed -- low cholesterol diets with a healthy fat content are now the order of the day. She encouraged the audience members to cut back on sugar, as sugar that is not used by the body is converted to fat and stored. She noted that the increased fat around the abdomen that is part of lipodystrophy increases the risk of heart disease, and that patients must try to minimize other risk factors, especially if they have a family history of heart disease. Ms. Tinnerello suggests oatmeal for breakfast everyday to help lower cholesterol.
Ms. Tinnerello also emphasized the importance of adequate calcium intake. Calcium is required for nerve transmission and the regulation of heartbeat, is constantly consumed in the body, and must be replaced. Adequate calcium intake also helps prevent osteoporosis, an increasingly common condition in people with HIV. Good sources of calcium beyond the milk group are leafy green vegetables, sardine bones, and salmon bones. Calcium supplements, weight lifting, and vitamin D supplements can also help prevent osteoporosis.
The presentations showed the audience that people with HIV may not have to put up with all side effects -- there are ways to address treatment toxicity. It may be possible to use medication therapy or to make an adjustment to a diet or exercise routine that will alleviate the side effect. Appropriate side effect management can help people with HIV stay on their medication regimens for the long haul, and is an important part of HIV care.