January 2006
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 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.
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.
For more information on these topics, read Project Inform's publications, Lipodystrophy, Mitochondrial Toxicity and Lactic Acidosis, Bone Complications, and Drug Interactions.
TDD = total daily dose
|
Fusion Inhibitors: Protease Inhibitors: |
Nucleoside (NRTI) and Nucleotide (NtRTI) Reverse Transcriptase Inhibitors: Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI): |
Fuzeon (enfuvirtide, T20) | |||
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. No cross resistance with other anti-HIV drugs. No significant drug interactions.
Manufacturer and website: Roche Laboratories/Trimeris; www.fuzeon.com |
Agenerase (amprenavir, APV) | |||||||||
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: GlaxoSmithKline; www.gsk.com/products/prescription_medicines/us/agenerase_us.htm |
Aptivus (tipranavir, TPV) | |||
Works best when taken with Fuzeon. Should be taken with caution by anyone with liver problems (including hepatitis B and C). Most common side effects are diarrhea, nausea, fatigue. Aptivus has many drug interactions. Consult the prescription packet for more information.
Manufacturer and website: Boehringer Ingelheim; www.aptivus.com |
Crixivan (indinavir, IDV) | |||||||||||||
Should be taken on empty stomach, at least 1 hour before or 2 hours after a meal.
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. Patient Assistance Program: 1-800-850-3430, or www.crixivan.com/indinavir_sulfate/crixivan/support/index.jsp Manufacturer and website: Merck & Co.; www.crixivan.com |
Invirase (saquinavir, SQV) | ||||||
Side effects of both are relatively rare. Most common include diarrhea and nausea. Invirase has many drug interactions. Consult the prescription packet for more information.
Manufacturer and website: Roche Pharmaceuticals; http://invirase.com/default.asp |
Kaletra (lopinavir + ritonavir, LPV + RTV) | ||||||
Can be taken with or without food. Dose of Kaletra should be increased to four capsules twice a day if taken with Sustiva or Viramune. Kaletra has many drug interactions. Consult the prescription packet for more information.
Manufacturer and website: Abbott Laboratories; www.kaletra.com |
Lexiva (fosampreanvir, FAV) | |||||||||
Similar side effects and resistance to Agenerase (see above). With Norvir (RTV) boosting: refer to dosing schemes #2 or #3 above.
Manufacturer and website: GlaxoSmithKline; www.lexiva.com |
Norvir (ritonavir, RTV) | |||
People with liver dysfunction (hepatitis B or C, etc.) should be cautious when using Norvir. When starting Norvir, should use 300mg 2x/day for 2 days, 400mg 2x/day for 2 days, 500mg 2x/day for 2 days, and then standard 600mg 2x/day dose. Norvir has many drug interactions. Consult the prescription packet for more information. Consult your doctor or pharmacist about dosing of oral solution.
Manufacturer and website: Abbott Laboratories; www.norvir.com |
Reyataz (atazanavir, ATV) | ||||||
Should be taken with food. No observed effect on cholesterol and triglycerides. Some people (35-47%) get elevated bilirubin levels, which do not indicate liver problems. Should not be taken with long acting acid reducers, Dose adjustments needed with Sustiva and Videx/Videx EC. Reyataz has many drug interactions. Consult the prescription packet for more information. Reyataz must be boosted with Norvir when taken with Viread.
Manufacturer and website: BristolMyersSquibb; www.reyataz.com |
Viracept (nelfinavir, NFV) | ||||||||||||||||
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.) Patient Assistance Program: 1-888-706-2400; or http://pfizerhelpfulanswers.com Manufacturer and website: Pfizer Inc.; www.viracept.com |
Combivir (lamivudine + zidovudine, 3TC + AZT) | |||
Can be taken with or without food. See comments in Retrovir and Epivir sections.
Manufacturer and website: GlaxoSmithKline; www.combivir.com |
Emtriva (emtricitabine, FTC) | |||
Side effects from Emtriva are rare, with headache, diarrhea, nausea, and rash the most common. Close cousin to Epivir. Cross-resistant to Epivir. No significant drug interactions.
Manufacturer and website: Gilead Sciences; www.emtriva.com |
Epivir (lamivudine, 3TC) | ||||||
Side effects associated with Epivir are rare, but may include headaches, nausea, general sense of feeling ill, diarrhea, anemia and hair loss. Close cousin to Emtriva. Cross-resistant to Emtriva. Consult your doctor or pharmacist about dosing the oral solution.
Manufacturer and website: GlaxoSmithKline; www.treathiv.com/products/epivir.html |
Epzicom (abacavir + lamivudine, ABV + 3TC) | |||
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.
Manufacturer and website: GlaxoSmithKline, www.epzicom.com/about.html |
Retrovir (zidovudine, AZT) | |||||||
Most common side effects are headache, nausea and general sense of feeling ill. Side effects usually diminish after 6-8 weeks of therapy. Can cause anemia. Should not be used together with Zerit. Patient Assistance Program: 1-866-728-4368, or http://bridgestoaccess.gsk.com Manufacturer and website: GlaxoSmithKline; www.treathiv.com/products/retrovir.html |
Trizivir (lamivudine + acabavir + zidovudine, 3TC + ABV + AZT) | |||
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.
Manufacturer and website: GlaxoSmithKline; www.treathiv.com/products/trizivir.html |
Truvada (emtricitabine + tenofovir, FTC + TDF) | |||
See comments in the Viread and Emtriva sections.
Manufacturer and website: Gilead Sciences; www.truvada.com |
| ||||||||||||
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: 2/x day dosing is recommended over 1x/day.
Manufacturer and website: Bristol-Myers Squibb; www.videxec.com |
Viread (tenofovir, TDF) | |||
Potential side effect is kidney dysfunction. Should be used with caution with other drugs that are eliminated by the kidneys, such as ganciclovir and valacyclovir. When used with Reyataz, Reyataz must be boosted with Norvir. Should not be used together with Ziagen. When used with Videx EC, the Videx EC dose should be changed to 250mg.
Manufacturer and website: Gilead Sciences; www.viread.com |
Zerit (stavudine, d4T) | ||||||
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) | |||
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.
Manufacturer and website: GlaxoSmithKline; www.treathiv.com/products/ziagen.html |
Rescriptor (delavirdine, DLV) | ||||||||
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. Patient Assistance Program: 1-888-777-6637 Manufacturer and website: Pfizer Inc.; www.rescriptor.com |
Sustiva (efavirenz, EFV) | ||||||
Most common side effect include neurological symptoms (primarily sleep disturbances, dizziness, drowsiness and lack of concentration). Should be taken at night to reduce likelihood of neurological side effects [using lorazepam (Ativan) or Benadryl may also help]. Should not be taken by pregnant women. Dose adjustments needed when used with Reyataz. Interacts with many protease inhibitors. Consult the prescription packet for information.
Manufacturer and website: Bristol-Myers Squibb; www.sustiva.com |
Viramune (nevirapine, NVP) | |||
° 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.
Manufacturer and website: Boerhringer-Ingelheim; www.viramune.com |
