Claire Borkert, M.D.: The most noticeable side effects I have observed have been metabolic -- the so-called fat-redistribution syndromes, which in a woman translates to significantly enlarged breasts and abdomen. Women are complaining of back problems more frequently and are not uncommonly mistaken for being pregnant, which can be quite traumatic for some women. This may be more pronounced in women who were overweight to begin with, before starting HAART. Again, the overall effect this has on how women see themselves -- on their self-esteem -- can be devastating.
There are other potentially life-threatening concerns. Obese women over 40 are more likely to develop lactic acidosis, which has been linked to mitochondrial toxicity due to reverse transcriptase inhibitors.
Drug levels can also vary significantly in women. One study showed dramatic differences in the amount of time single-dose nevirapine [Viramune] stayed in the bodies of pregnant women. Generally, other studies have indicated that nevirapine may clear more slowly from women's bodies, making them more at risk potentially for rash and liver toxicities. Obviously, more pharmacokinetic studies of nevirapine in women [how women's bodies process the drug] need to occur.
Victoria Cargill, M.D.: We're seeing a few things:
- Menstrual irregularities, like amenorrhea (no menstrual periods), polymenorrhea (periods come too often) and oligomenorrhea (periods don't come often enough).
- Body composition changes: some women complain of breast enlargement or increased abdominal girth that is not very responsive to increased aerobic exercise.
- Sexual function changes: decreased sexual interest, delayed or difficult orgasm (all of these may be secondary to the psychological issues around transmission and safety).
Ruth Greenblatt, M.D.: I am not so sure if the side effects are different, or if they are of different significance to women. Body habitus (build) changes are of great concern. For women, fat accumulation in the abdomen and breast enlargement can be mistaken for pregnancy. Hair loss is a common complaint, but not exclusively in association with antiretroviral therapies. Probably anecdotally, several of my female patients have had severe sleep disturbances and dysphoria [feeling unhappy or unwell] with efavirenz [Sustiva, Stocrin], though other providers in our program have used the medication without a problem.