Side effects can be serious. They can impact day-to-day living. They can be dangerous and negatively affect one's ability to stay on drugs properly. This last point was made especially clear by many women's stories of self-prescribed dosing and self-dose reduction. As one woman who self-dosed without her doctor's knowledge said: "There's my doctor's dose, and then there's my dose. My dose is the only thing that works for me... cutting it in half is the only way I can stand the pills."
While her reasoning may sound appealing, self-dosing is dangerous. Self-dosing and dose reduction are recipes for speeding the development of drug resistance. Changing your regimen without your provider's knowledge and instruction can cause a lot more trouble in the long run than dealing with the side effects themselves.
Learning about side effects and how to best manage them and talking with your provider about what you're experiencing will keep you healthier, longer. Because this is such an important concern, the entire next issue of WISE Words will be dedicated to side effects and their management. A sample of the issues discussed at the conference follows.
A new study shows that epoetin alfa (Epogen®, Procrit®) is useful in treating mild-to-moderate anemia in women living with HIV. Epoetin alfa had been shown effective in treating HIV and HIV drug-related anemias for HIV-positive people in general. The new study proves this point is equally true in women.
Epoetin alfa was effective in treating AZT-related anemia, as well as anemia related to HIV or other anti-HIV drugs. Women in the study received epoetin alfa once a week by injection for eight weeks. Overall, the drug was well tolerated with minor side effects, including body aches, nausea and fever.
Among positive women, anemia is independently connected with high viral load (over 50,000 copies) and low CD4+ cell count (less than 200 cells). Anemia is also linked with the use of AZT (zidovuidine, Retrovir®), African American race and a MCV count less than 80 (mean corpuscular volume, a measure of red blood cells).
Bottom Line: know your viral load, CD4+ cell count and hemoglobin count. When you consider starting or switching anti-HIV therapy, think about your risk for developing anemia and take into consideration drugs linked to anemia.
The study also reported that women are more likely to have a rash from nelfinavir (Viracept®) than men (5% vs. less than 2%, respectively). Talk to your doctor if you're starting a drug which may cause rash and learn how to monitor for its early signs. Keep medications like Benadryl on hand to manage the rash should it appear. If you experience a rash, call your provider immediately.
Menstrual irregularities are also associated with HIV disease itself and may not always be directly related to insulin levels. More information regarding insulin, menstruation and body shape changes is expected soon.
Lipodystrophy is currently a catch-all term. It's used to refer to certain changes in body shape and changes in lab results that reflect the way the body processes fats, sugars and proteins.
Lactic acidosis has long been linked to the use of anti-HIV therapy, specifically the nucleoside analogue reverse transcriptase inhibitors (NARTIs). Have your lactate levels checked quarterly to determine your risk for developing this condition. Anecdotal reports suggest that some vitamins such as coenzyme Q10 may prevent lactic acidosis, but they need to be confirmed in studies.