A side effect that may be related to anti-HIV therapy is body composition changes or changes in fat distribution, called lipodystrophy. This might include fat loss in areas (lipoatrophy) or fat accumulation in others (lipohypertrophy). This includes fat loss in the face (sunken cheeks); loss of fat in the arms and legs; loss of shape in the buttocks; breast enlargement; fat pad in the back of the neck (sometimes called buffalo hump); and increase in fat around the gut (sometimes called central or truncal obesity or protease paunch). Possible related side effects include changes in laboratory measures of how the body processes fats and sugars. This includes changes in cholesterol, triglyceride and blood glucose levels.
Mitochondrial Toxicity
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Mitochondrial toxicity is a side effect that may be caused by the anti-HIV drugs called NRTIs. Symptoms can include muscle cell destruction and weakness (myopathy), numbness and tingling in fingers and toes (peripheral neuropathy), and inflammation of the pancreas (pancreatitis). One potentially life-threatening outcome of this condition is lactic acidosis, a result of abnormally high levels of lactate in the body's cells. In early stages of lactic acidosis, people experience muscle weakness, shortness of breath, nausea, vomiting and pain in the gut. Another outcome of mitochondrial toxicity is hepatic steatosis, or "fatty liver", and often leads to lactic acidosis.
Bone Problems
Other side effects that anti-HIV therapy may cause are bone complications, including avascular necrosis and osteonecrosis. These are caused by a lack of blood supply in the bone that leads to deterioration and death of bone tissue. This may then lead to the bone fracturing or collapsing.
Standard dosing (2x/day): one injection under the skin (subcutaneous) = 1ml (90mg); TDD = 2ml (180mg).
Dose 1 (1ml/90mg)
Dose 2 (1ml/90mg)
Most common side effect: injection site reactions (98%) including redness, pain, itching, swelling and hardened skin at site of injection.
Rare hypersensitivity reactions have occurred and should be reported immediately to your doctor. Signs include trouble breathing, fever with vomiting and rash, blood in urine and swelling of feet.
People on Fuzeon in studies got bacterial pneumonia more often than people not on Fuzeon.
Manufacturer and website: Roche Laboratories/Trimeris; www.fuzeon.com
Protease Inhibitors
Agenerase (amprenavir, APV)
Standard dosing (2x/day): one pill = 150mg; TDD = 2,400mg.
Dose 1 (1,200mg)
Dose 2 (1,200mg)
Norvir-boosted (RTV) dosing #1 (2x/day): one pill = APV 150mg, RTV 100mg; TDD = APV 1,200mg, RTV 200mg.
Dose 1 APV (600mg) + RTV (100mg)
Dose 2 APV (600mg) + RTV (100mg)
Norvir-boosted dosing #2 (1x/day): one pill = APV 150mg, RTV 100mg; TDD = APV 1,200mg, RTV 200mg.
Dose 1 APV (1,200mg) + RTV (200mg)
Side effects include rash, fatigue, vomiting, headache and diarrhea.
Can be taken with or without food.
People on the oral solution should avoid alcohol.
Oral solution should not be taken by pregnant women, children under age of four, people with liver or kidney failure, or people taking disulfiram or metronidazole.
Manufacturer and website: Boehringer Ingelheim; www.aptivus.com
Crixivan (indinavir, IDV)
Standard dosing (3x/day): one pill = 400mg; TDD = 2,400mg.
Dose 1 (800mg)
Dose 2 (800mg)
Dose 3 (800mg)
Must be taken every 8 hours.
Should be taken on empty stomach, at least 1 hour before or 2 hours after a meal.
Norvir-boosted (RTV) dosing #1 (2x/day): one pill = IDV 400mg, RTV 100mg; TDD = IDV 800mg, RTV 800mg.
Dose 1 IDV (400mg) + RTV (400mg)
Dose 2 IDV (400mg) + RTV (400mg)
Norvir-boosted dosing #2 (2x/day): one pill = IDV 400mg, RTV 100mg; TDD = IDV 1,600mg, RTV 200mg.
Dose 1 IDV (800mg) + RTV (100mg)
Dose 2 IDV (800mg) + RTV (100mg)
Norvir-boosted dosing #3 (2x/day): one pill = IDV 400mg, RTV 100mg; TDD = IDV 1,600mg, RTV 400mg.
Dose 1 IDV (800mg) + RTV (200mg)
Dose 2 IDV (800mg) + RTV (200mg)
Most serious side effect is kidney stones. Drink large amounts (8 glasses) of water daily to reduce risk.
If taken in a combination with Videx, take indinavir at least 1 hour before or 2 hours after Videx. A newer version of Videx, called Videx EC, can be taken at the same time as Crixivan.
Crixivan has many drug interactions. Consult the prescription packet for more information.
Manufacturer and website: BristolMyersSquibb; www.reyataz.com
Viracept (nelfinavir, NFV)
Standard dosing #1 (3x/day): one pill = 250mg; TDD = 2,250mg.
Dose 1 (750mg)
Dose 2 (750mg)
Dose 3 (750mg)
Standard dosing #2 (2x/day): one pill = 250mg; TDD = 2,500mg.
Dose 1 (1,250mg)
Dose 2 (1,250mg)
Standard dosing #3 (2x/day): one pill = 625mg; TDD = 2,500mg.
Dose 1 (1,250mg)
Dose 2 (1,250mg)
Norvir-boosted (RTV) dosing #1 (2x/day): one pill = NFV 250mg, RTV 100mg; TDD = NFV 1,000mg, RTV 800mg.
Dose 1 NFV (500mg) + RTV (400mg)
Dose 2 NFV (500mg) + RTV (400mg)
Norvir-boosted dosing #2 (2x/day): one pill = NFV 250mg, RTV 100mg; TDD = NFV 1,500mg, RTV 800mg.
Dose 1 NFV (750mg) + RTV (400mg)
Dose 2 NFV (750mg) + RTV (400mg)
Should be taken with food.
Consult your doctor or pharmacist about dosing the oral solution.
Most common side effect is diarrhea, may be controlled with over-the-counter therapies like Imodium or "bulking agents". (Note: Imodium may cause drowsiness, may be useful to take in the evening.)
Standard dosing (1x/day): one pill = ABV 600mg/3TC 300mg; TDD = ABV 600mg/3TC 300mg.
Dose 1 (ABV 600/3TC 300mg)
A combination of Ziagen and Epivir.
No food restrictions.
See Ziagen and Epivir sections for information on side effects.
About 5% of people develop a hypersensitivity to Ziagen, resulting in flu-like symptoms or respiratory involvement including shortness of breath, cough or inflammation of the windpipe (pharynx). If this occurs, contact your doctor immediately; Epzicom (or Trizivir or Ziagen) should be stopped immediately. Do not restart Epzicom (or Trizivir or Ziagen) without doctor supervision as this can lead to severe side effects.
Standard dosing (2x/day): one pill = 3TC 150mg/ABV 300mg/AZT 300mg; TDD = 3TC 300mg/ABV 600mg/AZT 600mg
Dose 1 (3TC 150mg/ ABV 300mg/AZT 300mg)
Dose 2 (3TC 150mg/ ABV 300mg/AZT 300mg)
Should not be used by people who weigh less than 40kg (88 lbs) or who have liver or kidney dysfunction.
Can be taken with or without food.
See comments in Retrovir, Epivir and Ziagen sections.
About 5% of people develop a hypersensitivity to Ziagen, resulting in flu-like symptoms or respiratory involvement including shortness of breath, cough or inflammation of the windpipe (pharynx). If this occurs, contact your doctor immediately; Trizivir (or Epzicom or Ziagen) should be stopped immediately. Do not restart Trizivir (or Epzicom or Ziagen) without doctor supervision as this can lead to severe side effects.
Videx EC (didanosine, ddI EC) standard dosing #1 (1x/day): one pill = 400mg; TDD = 400mg.
Dose 1 (400mg)
Videx EC (didanosine, ddI EC) standard dosing #2 (1x/day, see notes): one pill = 250mg; TDD = 250mg.
Dose 1 (250mg)
Videx (didanosine, ddI) standard dosing #1 (2x/day): one pill = 100mg; TDD = 400mg.
Dose 1 (200mg)
Dose 2 (200mg)
Videx (didanosine, ddI) standard dosing #2 (1x/day): one pill = 200mg; TDD = 400mg.
Dose 1 (400mg)
Videx EC and Videx: Most serious side effect is pancreatitis, which has been fatal in some people. Symptoms include sharp pain in upper abdomen, nausea and vomiting. Stop drug immediately and consult a doctor if this occurs. Alcohol use increases risk of pancreatitis.
Must be taken on an empty stomach without food.
When used with hydroxyurea, may increase the risk for pancreatitis.
Most common side effects include increased uric acid levels (a measure of kidney function), headaches, sleeplessness, diarrhea and pain/tingling in feet and/or hands (peripheral neuropathy).
People under 60kg (132 lbs) should use 250mg once a day.
When used with Viread, the Videx EC dose should be changed to 250mg.
People with kidney dysfunction should consult their doctors about dosing.
Videx/Videx EC should not be used together with Zerit or by pregnant women or by women who are planning to conceive.
Dose adjustments needed when used with Reyataz.
Videx only: Cannot be taken within 2 hours of drugs that require an acidic stomach environment, including many protease inhibitors and common therapies, such as dapsone.
Manufacturer and website: Gilead Sciences; www.viread.com
Zerit (stavudine, d4T)
Standard dosing >60Kg or >132 lbs (2x/day): one pill = 40mg; TDD = 80mg.
Dose 1 (40mg)
Dose 2 (40mg)
Standard dosing <60Kg or <132 lbs (2x/day): one pill = 30mg; TDD = 60mg.
Dose 1 (30mg)
Dose 2 (30mg)
Can be taken with or without food.
Should not be taken with Retrovir.
Most common side effect is pain/tingling in feet and/or hands (peripheral neuropathy).
May cause anemia.
Rare incidence of pancreatitis has been observed. Symptoms include sharp pain in upper abdomen, nausea and vomiting. Stop drug immediately if this occurs. Alcohol use increases risk of pancreatitis.
° Using Videx/Videx EC or hydroxyurea may increase the risk for pancreatitis.
Should not be used together with Retrovir or Videx/Videx EC or by pregnant women or by women who are planning to conceive.
Manufacturer and website: Bristol-Myers Squibb; www.zerit.com
Ziagen (abacavir, ABV)
Standard dosing (2x/day): one pill = 300mg; TDD = 600mg.
Dose 1 (300mg)
Dose 2 (300mg)
Can be taken with or without food.
Should not be used together with Viread.
Most common side effects include nausea, vomiting, headache and fatigue.
About 5% of people develop a hypersensitivity to Ziagen, resulting in flu-like symptoms or respiratory involvement including shortness of breath, cough or inflammation of the windpipe (pharynx). If this occurs, contact your doctor immediately; Ziagen (or Trizivir or Epzicom) should be stopped immediately. Do not restart Ziagen (or Trizivir or Epzicom) without doctor supervision as this can lead to severe side effects.
Standard dosing #1 (3x/day): one pill = 100mg; TDD = 1,200mg.
Dose 1 (400mg)
Dose 2 (400mg)
Dose 3 (400mg)
Standard dosing #2 (3x/day): one pill = 200mg; TDD = 1,200mg.
Dose 1 (400mg)
Dose 2 (400mg)
Dose 3 (400mg)
Can be taken with or without food.
Can be dissolved in water or other liquids if drank immediately.
Most serious side effect is severe rash, which may require hospitalization. Rash usually occurs within first 3 weeks of starting drug. Mild rashes can be managed with antihistamines or topical agents.
Rescriptor has many drug interactions. Consult the prescription packet for more information.
Manufacturer and website: Bristol-Myers Squibb; www.sustiva.com
Viramune (nevirapine, NVP)
Standard dosing (2x/day): one pill = 200mg; TDD = 400mg.
Dose 1 (200mg)
Dose 2 (200mg)
Small (4%) chance of serious liver toxicity. Most liver problems occur during the first 18 weeks of therapy, but can happen at any time.
° Women and people with high CD4+ cell counts may be at increased risk.
Another serious side effect is severe rash, which may require hospitalization. Rash usually occurs within first 3 weeks of starting drug. Mild rashes can be managed with antihistamines or topical agents.
Dose is escalated over first 2 weeks, typically beginning at 1x200mg tablet daily increased to 2x200mg tablets after 14 days.
Can be taken with or without food.
Consult your doctor or pharmacist about dosing for the oral solution.
Patient Assistance Program: 1-800-556-8317, or www.rxhope.com
Manufacturer and website: Boerhringer-Ingelheim; www.viramune.com
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