how do you make sense of your treatment options? begin ... · as you begin to think about starting...

How Do You Make Sense of Your Treatment Options?

Begin with your health care professional. Use this booklet.

Then visit TheBody.com/treatment for more information.

Founded in 1995, TheBody.com is the most comprehensive HIV/AIDS resource on the Internet, serving more than 1 million visitors a month.

HIV Medications HIV Medications

A Roadmap to Success

When to Startand What to Take

When to Startand What to Take

A S P E C I A L R E P O R T F R O M T H E B O D Y . C O M

DECEMBER 2010 EDITION

Table of ContentsHIV Medications: The Basics ................................................................................ 1

When to Start Treatment? .................................................................................... 2

What Is a T-Cell or CD4 Count? ....................................................................... 3

What Is Viral Load? ........................................................................................................ 3

Preparing to Start Treatment ............................................................................ 5

What to Start Treatment With? ...................................................................... 8

Considering Your Options? .................................................................................. 9

Why an Experienced Doctor Is Best .............................................. 15

Meet the Meds................................................................................................................... 16

Why Do HIV Drugs Have so Many Different Names? 17

Chart: Once- and Twice-a-Day Medications ......................... 18

Special Considerations:

HIV Treatment and Women ..................................................................... 24

Getting Pregnant When You’re HIV Positive ..................... 25

HIV Treatment for People Coinfected With Hepatitis 25

You’ve Started Treatment: What Now? ................................................ 26

CONSULT YOUR DOCTOR! The only purpose of this booklet is to educate and to inform. It is no substitute for professional care by a doctor or other medical professionals. Body Health Resources Foundation neither endorses nor opposes any particular treatment option discussed in this booklet—instead, we encourage you to discuss all your options with a health care provider who specializes in treating HIV.

We wish to thank Ben Young, M.D., Ph.D., for his generosity in providing a medical review of this booklet. Funding for this booklet comes in part from an educational grant provided by Boehringer Ingelheim.

© 2010 The HealthCentral Network, Inc. All rights reserved.

Farbe/colour:PANTONE 288 CV

IV treatment has come a long, long way. Just 10 years ago, starting HIV treatment meant taking a handful of medications

several times a day. It also meant dealing with some potentially serious side effects. But with each passing year, researchers develop new medications and improve on existing ones. As a result, HIV treatment today is safer and more effective than it’s ever been.

HIV treatment is the single best way to prevent HIV from damaging your body—and to repair some of the damage HIV may have already done.

Nonetheless, determining when it’s time to begin HIV treatment and deciding which medications to take are both big decisions. HIV medications may be safer and more effective than ever, but they still bring their own risks. That’s why it’s important that you arm yourself with as much reliable information as possible. And it’s equally important to find an experienced HIV doctor who you can trust to help you make important decisions about your HIV treatment and overall health care. (You can ask an HIV/AIDS service organization or case manager in your area for help finding a good HIV doctor. If you have Internet access, you can use our search tool at ASOFinder.com to find an organization near you.)

At least once every three to six months, you should visit your HIV care provider for a checkup. This will help you both stay on top of your health and make treatment adjustments as needed.

As you begin to think about starting HIV treatment, there are many issues to consider. We hope this booklet will help guide you through the process! o

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HIV Medications: The BasicsHIV Medications: The Basics

octors still disagree about when is the best time to begin HIV treatment, also called antiretroviral therapy. You and your

doctor will need to determine this together, but there are some respected guidelines. Be aware that these guidelines are regularly updated and are not hard-and-fast rules. They are just suggestions based on the most recent research.

In the U.S., the most respected HIV treatment guidelines are created by a team of experts brought together by the U.S. Department of Health and Human Services, or DHHS for short.

Once you start taking HIV medications, you’ll probably have to take them for a very long time, so you and your doctor will want to make sure you are absolutely ready before you begin treatment. This way you can postpone possible medication side effects (which we talk about later in this booklet) and make the most of the powerful initial effect medications can have on the HIV in your body.

When to Start Treatment?When to Start Treatment?

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D

Current Guidelines Recommend:If your CD4 count is above 500, you can hold off on HIV medications, but many experts

feel it’s good to start, just to be safe.

If your CD4 count is between 350 and 500, you should begin treatment to protect your immune system

from future damage.

If your CD4 count is below 350, or if you’ve ever had an AIDS-defining illness, you should start

treatment immediately to avoid serious health problems.

If your CD4 count is above 500, you can hold off on HIV medications, but many experts

feel it’s good to start, just to be safe.

If your CD4 count is between 350 and 500, you should begin treatment to protect your immune system

from future damage.

If your CD4 count is below 350, or if you’ve ever had an AIDS-defining illness, you should start

treatment immediately to avoid serious health problems.

Your T-cell count, also known as a CD4 count, reveals the number of T cells in your body. A T cell is a special kind of white blood cell, and the more you have, the stronger your immune system is. When you were infected with HIV, the virus entered into some of your T cells. When these HIV-infected T cells make more co-pies of themselves, they end up making more copies of HIV as well. HIV can also destroy T cells, as well as other surrounding cells. After living with HIV for a while (if you don’t take medica-tions) the number of T cells you have will usually go down. This is a sign that your immune system is being weakened. The lower your T-cell count, the more you risk getting sick. A normal T-cell count for someone without HIV is usually be-tween 500 and 1,600.

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What Is Viral Load?Viral load levels tell you and your doctor how much HIV is circulating in your blood. The more HIV in your system, the quicker your T-cell count tends to drop. This makes viral load a helpful predictor of the health problems you may develop if you do not take medication. It is also a good measure of how well HIV medications are working once you begin treatment.

Your viral load count measures the amount of HIV per milliliter (mL) of your blood. Current viral load tests can detect as few as 50 copies of HIV per milliliter of blood. When you have fewer than 50 copies/mL of HIV, your doctor will tell you that your viral load is “below the limit of detection,” or “undetectable.” This does not mean that there is no more HIV in your body. So even if you are “undetectable,” you can still transmit HIV to someone.

What Is a T-Cell or CD4 Count?

Getting Into Good Habits Before You Start Treatment

Even if you’re not about to begin HIV treatment, now’s the perfect time to revisit some of your habits to be sure they’re healthy. Even the most effective HIV medications can’t overcome an unhealthy lifestyle.

Now is the time to begin eating healthier, exercising regularly, and cutting out cigarettes, recreational drugs or excessive use of alcohol—all of which have been shown to have a dangerous effect on the immune systems of people with HIV.

In addition, it’s important for you and your HIV doctor to have a full picture of everything you’re putting into your body. If you are taking any prescription drugs, over-the-counter medications, vitamins or supplements —any at all, no matter how unimportant they seem—make sure you tell your doctor so that you can avoid dangerous interactions with HIV medications.

For example, antihistamines, birth-control pills and recreational drugs all have been shown to have serious interactions with some HIV medications. Even the seemingly harmless herb St. John’s wort can reduce the strength of some HIV meds.

Does he or she listen to you? Choosing a doctor you can talk to is crucial. You’ll probably have many questions; make sure your doctor is available and able to answer them before you make any decision about starting HIV treatment.

Can You Really Talk to Your Doctor?

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Preparing to Start TreatmentPreparing to Start Treatment

nce your doctor recommends that you begin treatment, it’s important to consider how treatment will change your

life. Are you ready in every way—mentally as well as physically? Remember: Each missed dose of an HIV medication may increase the risk that your meds will lose their ability to keep your HIV under control. This means you have to be certain that taking your medications will become a central part of your daily life.

No doubt this commitment will be challenging. However, you have a good chance of keeping HIV under control with the first combination of medications that works for you. If this combination successfully suppresses the virus, and if you take each and every pill prescribed, you may not have to change medications for a long time.

What if you aren’t always able to take all your medications on time? This may cause your first combination of medications to fail. If this happens, it can get harder and harder to keep HIV under control with each successive drug combination. So it’s crucial to identify a combination you can stick to, before you start treatment.

Here are some things to consider:

• HIV treatment is a commitment; be ready for it. One thing is certain: Taking medications daily will change your life. Suddenly, you’ll have new responsibilities. You’ll always

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have to be aware of the time, your schedule and changes in your routine. In some cases you may have to schedule taking your HIV medicine around meals or take it with or without certain foods. You’ll have to remember to take your pills with you if you are going out at night or away for the weekend. Even if you are depressed or busy, you will still have to take your medications exactly as prescribed every single day. So, before you start, you must ask yourself: “Am I really ready?”

n Anything that could interfere with taking all your pills on time. Travel? The timing of meals?

n Your support system. Can you count on your friends? Family? Therapist? Support group?

n Sequencing of HIV medications. Ask your doctor what options you’ll still have if your first combination stops working.

n Strength of HIV medications. Which medications are right for you given your T-cell count and viral load?

n How long the drug has been around. What is known about short- and long-term side effects?

n Side effects. Are some side effects more tolerable to you than others? How will you manage them if they arise?

n Drug interactions. Certain HIV meds don’t always get along with other drugs. Will yours work with other meds you’re taking?

Details, Details: More Things to Keep in MindWhen Choosing Treatment

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• Plan how you will deal with side effects if they occur. All medications can have side effects—even aspirin. Not everyone experiences side effects from HIV medications, which can range from mild to severe. Because you really want to give this first combination your best shot, talk to your doctor and read about the possible side effects of the medications you are thinking of taking. This can help you not only plan how to manage side effects if they arise, but to choose medications whose possible side effects you think you can manage.

• Your surroundings and your mental health are important.If you are feeling depressed, using recreational drugs or living on a friend’s couch, it may be unrealistic to assume you’ll be able to take all your medications all the time. So make sure you have organized your life before you begin treatment. This way it will be easier for you to follow a strict treatment plan. It’s also a good idea to get some support. It helps immensely to have friends, family or a therapist you can rely on while you are on a treatment regimen—especially at the beginning when you are still adjusting. Check out the HIV/AIDS service organizations near you for support groups.

To find an HIV/AIDS service organization online, visit our search tool at ASOFinder.com. o

here are more than two dozen U.S. government-approved HIV medications. However, none of these medications can cure

HIV, and no single drug taken alone is effective. But when several medications (usually three or four) are taken in combination, they can control the quantity of virus in your body and maintain the health of your immune system. This combination is called Highly Active Anti-Retroviral Therapy, or HAART.

There are five different types, or “classes,” of HIV medications:n Entry inhibitors n Integrase inhibitorsn NNRTIs (non-nucleoside reverse transcriptase inhibitors)n NRTIs (nucleoside reverse transcriptase inhibitors)n PIs (protease inhibitors)

All five classes of medications have been designed to interfere with HIV’s ability to copy itself—that is, to reproduce inside your body. Each class of medication stops the virus at a different moment in its reproductive cycle.

All HAART regimens consist of medications from at least two of these five classes. That way, your treatment can hit HIV from at least two directions at once, increasing the chances that treatment will be a success.

With so many HIV medications available, how can you and your doctor be sure that you’re putting together a regimen of the best possible medications for you? Choosing a regimen isn’t always the easiest thing to do, but with a knowledgeable HIV doctor on your side, you can pick a HAART regimen that will keep the HIV in your body off balance for many, many years—provided you take your doses properly.

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What to Start Treatment With?What to Start Treatment With?

What to Start Treatment With?What to Start Treatment With? Considering Your OptionsConsidering Your Optionshere are many different possible combinations of HIV medications that can make up a HAART regimen, and no

single combination is going to be the “best” for everyone. However, researchers are constantly working to determine whether certain combinations generally work better than others.

According to the December 2009 edition of the U.S. DHHS guidelines (the most recent version as of the release of this booklet), these HAART regimens are considered “preferred” for people who are just starting HIV treatment:

n Atripla (a single pill containing three HIV meds)n Truvada (a two-drug pill) plus Reyataz, boosted with Norvir n Truvada plus Prezista, boosted with Norvirn Truvada plus Isentressn If you’re pregnant, Combivir (a two-drug pill) plus twice-daily Kaletra

You can learn more about each of these drugs in the chart beginning on page 18.

There are a number of key things you and your doctor should consider before choosing one of these regimens (or another regimen entirely).

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“Boosted” Medications?Any medication that increases the power of another medication can be called a booster. In HIV treatment, a small dose of Norvir, a protease inhibitor, is often used as a booster for other protease inhibitors, such as Prezista and Reyataz. One drug, Kaletra, is considered a boosted combination since it consists of lopinavir and a small dose of Norvir.

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Drug ResistanceYou have every reason to hope that your first treatment regimen will keep your HIV under control for years and years. However, sometimes a person’s first regimen stops working.

The most common reason for a treatment combination to stop working is “resistance.” This means that the HIV in your body has adapted to one or more of the medications you are taking and, as a result, the medications no longer have the power to prevent your virus from multiplying inside your body.

Some people can even be infected with a strain of HIV that is already resistant to certain medications. (Before you start treatment, your doctor should perform a “resistance test” to determine whether this is the case with you.) Usually, though, resistance happens after you’ve begun treatment. The most common cause is when you don’t “adhere” to your treatment (that is, take your HIV meds on time).

How will you know if your treatment regimen has stopped working? Take a look at the results of your T-cell count and viral load tests. If you’ve always been taking your treatment on time, your viral load should drop at least 90 percent within two months of beginning treatment. Within six months, it should drop so low as to be “undetectable” (fewer than 50 copies/mL), and then remain that way indefinitely.

If your viral load does not more or less follow this pattern, your treatment may not be working properly. Similarly, a drop in your T-cell count may be a sign that your regimen isn’t working right. There may be other reasons for a drop in T-cell count, however. For instance, you may have a cold or another illness. And in a small

•

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number of cases, an HIV treatment regimen simply isn’t effective against a person’s HIV for unknown reasons. Regardless, be sure to talk with your doctor if you’re concerned that your HIV treatment may not be working as well as it should.

If your HIV becomes resistant to one or more medications in your regimen, you will likely need to switch to a new regimen. This is where an experienced HIV doctor really comes in handy, because the type of resistance your HIV has developed will directly impact the next HAART regimen you take.

For example, if your regimen includes an NNRTI and the NNRTI stops working, other NNRTIs may lose their ability to fight your virus. Fortunately, years of drug development have given us newer HIV medications within drug classes that are still likely to work even when your HIV becomes resistant to a drug in that class. People have more options today than they did just a few years ago.

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PotencySome combinations of HIV meds are more powerful than others, which can be useful if you have an especially high viral load or a particularly low T-cell count.

Drug InteractionsAlthough we all typically take drugs to prevent or treat various health problems, those drugs don’t always get along well with one another once they get into our bodies. Some HIV medications are known to “interact” with other medications in potentially harmful ways. In some cases, these interactions may make your doctor increase or decrease your dosage. In other cases, they may make your doctor recommend a different HIV medication (or a switch of the other medication you’re taking).

The risk of interactions is the main reason it’s extremely important to tell your doctor about all other drugs, pills and supplements you’re taking, no matter how harmless you think they might be.

Side EffectsEach drug within a combination brings a risk of side effects. Of course, not everyone will experience these side effects (listed in the charts you’ll see on pages 18 through 23). Some side effects, like nausea, rash or fever, can appear soon after you begin taking your drug combination and last only a short time (usually a few weeks). Other side effects, like fatigue or fat loss, can take longer to appear and may take longer to go away. Types of side effects include:

n Gastrointestinal problems. Many HIV medications, particularly Viracept and Kaletra, can cause diarrhea and other stomach

•

•

•

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problems, particularly at the beginning of treatment.

n High cholesterol or triglycerides (which can lead to heart disease) and insulin abnormalities (which can lead to diabetes). A multitude of studies have shown that many protease inhibitors, as well as some NRTIs and other HIV medications, can help cause these problems. However, newer drugs, such as the NRTI Viread and the protease inhibitors Lexiva and Reyataz, may be less likely to contribute to these problems. Researchers have also come to believe that other factors, such as whether a person smokes, is overweight or doesn’t exercise, may play a more important role in such problems than HIV medications do.

n Lipodystrophy. This is a condition in which specific parts of your body gain (“lipohypertrophy”) or lose (“lipoatrophy”) a large amount of fat. It is one of several problems doctors call “metabolic complications.”

A number of factors, including HIV itself and some HIV medications, can contribute to body shape changes in HIV-positive people. Newer HIV medications don’t seem to cause body shape changes.

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n Nerve problems. Some NRTIs (like Zerit and Videx), as well as HIV itself, can cause damage to parts of a person’s nervous system, leading to tingling, burning and numbness in the hands and feet—a disorder known as neuropathy.

n Psychological problems. Some medications, like the NNRTI Sustiva, may trigger depression, anxiety or unusual dreams. This may be an issue if you’re already depressed or have a history of serious mental disorders. Usually, however, these side effects do not last long.

Unfortunately, this is only a partial listing of the types of side effects that HIV medications are known to sometimes cause. Although HIV medications are lifesaving treatment, they are far from perfect. And the truth is, sometimes their side effects can be dangerous, especially if you are already at risk for the health problems they can cause or worsen.

Ask your doctor for a complete rundown of the side effects that particular HIV medications may cause. It’s impossible to predict which side effects you will experience (if any), or if you will have problems man-aging them. Certain side effects are easier to handle than others.

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Fortunately, the majority of side effects don’t last more than the first month or two after starting a medication.

No matter what, if you feel anything unusual—whether it’s mentioned in this booklet or not—be sure to tell your doctor or nurse right away. However, don’t stop taking your medications or change the way you’re taking your medications without first speaking with your doctor. If you stop treatment too suddenly or start skipping doses, you might accidentally cause drug resistance. o

For Side Effects and More, An Experienced Doctor Is Best

Why is it so important to find the most experienced HIV specialist you can? Since information about HIV is changing rapidly, a knowledgeable specialist will be in the best position to advise you when it comes to choosing the right treatment. Plus, you’ll be monitored carefully once you begin treatment. If any side effects occur, an experienced provider will have the most skill in helping you deal with them.

Your best option is to find someone who treats a minimum of five patients with HIV and has at least a few years of experience. Don’t be surprised if you are seen by a nurse practitioner or physician assistant. They can provide excellent care under the supervision of an HIV specialist.

Meet The MedsMeet the Meds

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ow that you’ve thought about the class or classes of HIV medications you should start with, it’s time to choose specific

medications. Besides considering all the things we’ve mentioned, there’s another important factor: How often will you need to take the pills?

Research has shown that it’s relatively easy for most people to take pills once or twice every day without missing doses. More than that, and most people slip up. You may even decide that once a day is easier than twice a day. The upcoming chart mentions which drugs can be taken once-daily and which are twice-daily. Please note that we have included some options that are commonly used by doctors although they may not yet be in any guidelines. o

n Some people find it helpful to use a small notebook to keep track of each time they take their medications.

n Others use a pillbox that they pre-fill at the beginning of each week or buy a watch with an alarm.

n Still others keep all their medications in one place, like near a toothbrush or in the kitchen, so they can remember to take them as a part of their daily routine.

n It also helps to fill your prescriptions consistently at one pharmacy. This way you can refill everything at once and not run out of certain medications. Mail-order pharmacies can offer a three-month supply and confidentiality that you may not get at your local pharmacy. If you are worried about timely refills, keep a week’s supply as a backup.

Forgetful? Here Are Some Tips:

Meet The MedsMeet the Meds

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Each HIV drug you read about here has several different names. Emtriva, for instance, is sometimes called FTC or emtricitabine. Why so many names for one drug? Here’s the deal:

n Generic name: A drug name in all lowercase letters (like “emtricitabine” or “nevirapine”) is the generic name—the official scientific name of the drug.

n Brand name: In order to patent an HIV drug, drug companies need to make a unique, “branded” version of a generic drug and give it a new name. The brand name, which always starts with a capital letter, is typically seen in ads, so it’s usually the most recognizable.

n Abbreviation: Using an abbreviation can make talking or writing about a drug easier. Sometimes, abbreviations are based on a drug’s generic name (like “ddI” for didanosine). Others are based on some of the key chemicals that make up the drug; that’s the case for AZT and FTC. Some abbreviations (like AZT) are so catchy that they become better known than the brand name.

n Combination Drugs: To make it easier to take HIV meds, some drug companies have created “fixed-dose combination” pills that contain more than one HIV medication in them. This may be convenient, but it can also make talking (or reading) about HIV meds harder, because it’s not always easy to tell whether someone is talking about a fixed-dose combination or the individual meds that go into that combination. Usually, though, fixed-dose combinations are known by their brand names: Atripla (Sustiva plus Emtriva plus Viread), Combivir (a combo of Epivir plus Retrovir), Epzicom (Epivir plus Ziagen), Trizivir (Epivir plus Retrovir plus Ziagen) and Truvada (Emtriva plus Viread).

Why Do HIV Drugs Have So Many Different Names?

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Meet the HIV MedicationsMeet the HIV MedicationsN

NR

TIs

Taken once daily; take on an empty stomach, preferably at bedtime

Sustiva(EFV, efavirenz)

NR

TIs

Available in once- or twice-daily doses; no food restrictions

Taken once daily; no food restrictions


Emtriva(FTC, emtricitabine)

Epivir (3TC, lamivudine)

Epzicom (combination of Ziagen + Epivir)

Intelence(TMC125, etravirine)

Taken twice daily; take with food

Taken thrice daily; take with or without food, but not with grapefruit juice

Rescriptor(DLV, delavirdine)

Atripla(combination of Sustiva + Viread + Emtriva)M

ult

i-Cla

ss

Co

mb

os Taken once daily; take

on an empty stomach or with a light snack


Viramune(NVP, nevirapine)

PICTURE & NAME OF MEDICATION DOSAGE NOTES SIDE EFFECTS & INTERACTIONS

Available in twice- or thrice-daily doses; no food restrictions

Combivir (combination of Epivir + Retrovir)

Taken twice daily; no food restrictions

Retrovir(AZT, zidovudine)

19*See pages 24-25 for typical class side effects.

• Don’t take with Atripla• Don’t take when pregnant or breast-feeding, or if you may become pregnant• May cause false-positive results on marijuana tests• May make PIs less effective, requiring doctors to increase their dosage• May interact with a number of non-HIV meds and supplements (check with your doctor)• Possible side effects*: depression, diarrhea, dizziness, fever, increased HDL cholesterol, increased liver enzymes, increased trigycerides, insomnia, memory loss, strange dreams, trouble concentrating

• Don’t take with Atripla, Combivir, Epivir, Epzicom, Trizivir or Truvada• Also fights hepatitis B (if part of an effective hep B regimen)• Possible side effects:*: rare, but include diarrhea, headache, nausea, rash, skin discoloration

• Don’t take with Atripla, Combivir, Emtriva, Epzicom, Trizivir or Truvada• Also fights hepatitis B (if part of an effective hep B regimen)• Possible side effects:*: rare, but include anemia, cough, diarrhea, fatigue, fever, hair loss, headache, nausea, nasal problems, trouble sleeping, vomiting

• Don’t take with Atripla, Combivir, Emtriva, Epivir, Trizivir, Truvada or Ziagen• Possible side effects and other warnings*: see Epivir and Ziagen

• Don’t take with Rescriptor, Sustiva, Viramune, any Norvir-boosted PI, or any of the following boosted PIs: Aptivus, Lexiva and Reyataz• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor)• Possible side effects*: allergic reaction (may be severe, but very rarely), cold-like symptoms, diarrhea, elevated liver enzymes, headache, nausea, rash

• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor), including some statins, blood pressure drugs, male sexual enhancement drugs, allergy nasal sprays, antacids and birth control pills• Possible side effects*: allergic reaction (may be severe) body fat changes, diarrhea, elevated liver enzymes, fatigue, headache, itchy skin, nausea, rash, vomiting

• Don’t take with Combivir, Emtriva, Epivir, Epzicom, Sustiva, Trizivir, Truvada or Viread• First pill to contain an entire regimen (meds from two drug classes, NNRTIs and NRTIs)• Possible side effects and other warnings*: see Emtriva, Sustiva and Viread

• Don’t take with Reyataz or the supplement St. John’s wort• Shouldn’t be used by women with T-cell count over 250, men with T-cell count over 400 • Approved as a twice-a-day drug, though some doctors prescribe it once a day • May make PIs less effective, requiring doctors to increase their dosage• May interact with a number of non-HIV meds (check with your doctor), including birth control pills• Possible side effects*: fever, headache, liver problems (may be severe), nausea, rash (may be severe), vomiting


Available in twice- or thrice-daily doses; no food restrictions

• Don’t take with Atripla, Emtriva, Epivir, Epzicom, Retrovir, Trizivir, Truvada or Zerit• Possible side effects*: anemia, muscle damage, neutropenia; also see Epivir and Retrovir

• Contained in the combination pills Combivir and Trizivir• Don’t take with Combivir, Trizivir or Zerit • May interact with a number of non-HIV meds, including some antibacterial drugs and some drugs used to fight anemia• Possible side effects*: anemia, chils, fatigue, fever, fingernail discoloration, musclesoreness, nausea

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Zerit(d4T, stavudine)

PIs

Meet the HIV Medications (continued)Meet the HIV Medications (continued)


Viread(TDF, tenofovir)


Ziagen(ABC, abacavir)

NR

TIs



Truvada (combination of Viread + Emtriva)

Available in once-or twice-daily doses; take on an empty stomach

Videx or Videx EC(ddI, didanosine)

Taken twice daily; no food restrictions, though taking with food may reduce nausea risk

Trizivir(combination of Epivir + Retrovir+ Ziagen)

Aptivus(TPV, tipranavir)

Taken twice daily; preferably with food because it’s taken with Norvir

Taken twice daily; take with food and lots of water

Crixivan(IDV, indinavir)

Taken twice daily; take with food or within two hours after a meal

Invirase(SQV, saquinavir)

21*See pages 24-25 for typical class side effects.

• Don’t take with Retrovir or Videx• Possible side effects*: anxiety, body fat changes, chills/fever, depression, increased triglycerides, nausea, neuropathy, rash, stomach pain, trouble sleeping, vomiting

• Don’t take with Atripla or Truvada• May interact with some other HIV meds in ways that could require dose changes• Use with caution if you already have bone or kidney problems• Possible side effects*: bone mineral density reduction, diarrhea, gas, kidney problems (not common), nausea, vomiting

• Contained in the combination pills Epzicom and Trizivir (don’t take either with Ziagen)• 5%-8% of people may have a severe, potentially life-threatening allergic reaction within 2 to 6 weeks of starting Ziagen (a “hypersensitivity test” can see whethe you’re at risk); if this happens, Ziagen should be stopped immediately and never taken again. • Use with caution if you have liver problems or are at high risk for heart disease • Other possible side effects*: diarrhea, fatigue, fever, headache, nausea, rash, vomiting


• Don’t take with Atripla, Combivir, Emtriva, Epivir, Epzicom, Trizivir or Viread• May interact with some other HIV meds in ways that could require dose changes• Possible side effects and other warnings*: see Emtriva and Viread

• May interact with some other HIV meds in ways that could require dose changes• Try to avoid taking with Zerit (increases risk of some side effects)• Possible side effects*: diarrhea, headache, neuropathy, pancreatitis (rarely), stomach

Taken twice daily; no food restrictions, though taking with food may reduce nausea risk

• Don’t take with Atripla, Combivir, Emtriva, Epivir, Epzicom, Retrovir, Truvada or Ziagen• May interact with a number of non-HIV meds, including some antibacterial drugs, antifungal drugs, cytomegalovirus drugs, hepatitis C drugs and methadone• Possible side effects and other warnings*: see Epivir, Retrovir and Ziagen

• Must be taken with Norvir • Use with caution (or avoid) if you have liver problems or hepatitis; if you’re on a blood thinner; or if you have a sulfa allergy• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor), requiring dose adjustment• Possible side effects*: diarrhea, fatigue, fever, headache, increased cholesterol/triglycerides, nausea, rash, stomach pain, vomiting

• Don’t take if pregnant; don’t take with Reyataz• Usually taken with Norvir (dose is thrice-daily by itself)• May interact with a number of non-HIV meds and supplements, including some statins, birth control pills, male sexual enhancement drugs and allergy nasal sprays• Possible side effects*: body fat changes, diarrhea, dry mouth/skin, fatigue, headache, hives, indigestion, ingrown toenails, joint pain, kidney stones, liver problems, stomach problems, yellow eyes/skin

• Must be taken with Norvir• Don’t take with Aptivus or Prezista• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor), requiring dose adjustment• Possible side effects*: diarrhea, nausea, stomach discomfort, vomiting

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1. NNRTI side effects include, with Sustiva, nervous system and psychiatric side effects, diarrhea, rash, fever. With Viramune, rash and liver complications can be seen. NNRTIs may lower the effectiveness of birth-control pills, so other contraceptives should be used. 2. Possible side effects for many NRTIs include pancreatitis, lactic acidosis and mitochondrial toxicity, which can cause neuropathy and wasting. Some NRTIs

*TYPICAL SIDE EFFECTS OF DIFFERENT MEDICATION CLASSES

Fuzeon(T-20, enfuvirtide)

Available in once- or twice-daily doses; must be taken with a meal (preferably with some fat in it)

Norvir(RTV, ritonavir)

Viracept(NFV, nelfinavir)

Taken twice daily; must be taken with food


Available in once- or twice-daily doses; must be taken with food

Prezista(TMC114, darunavir)

Meet the HIV Medications (continued)Meet the HIV Medications (continued)PIs

Selzentry(MVC, maraviroc)


Isentress(RAL, raltegravir)


En

try I

nh

ibit

ors

Inte

gra

se

Inh

ibit

ors


Reyataz(ATV, atazanavir)

Taken once daily; must be taken with food

Lexiva (FPV, fosamprenavir)


Kaletra(combination of lopinavir + Norvir)

Available in once- or twice-daily doses; try to take with food (may reduce risk of side effects)

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also contribute to high cholesterol and triglycerides. 3. Possible side effects of many protease inhibitors include high cholesterol and triglycerides, lipodystrophy (body fat changes), high blood sugar with development or worsening of diabetes and increases in liver function tests. PIs also lower effectiveness of birth control pills, so other contraceptives should be used.

• Powder that is mixed with sterile water and then injected under the skin• Possible side effects: diarrhea, fatigue, injection site reactions (hardened skin, itching, pain, swelling, tenderness), nausea

Available in once- or twice-daily doses; must be taken with a meal (preferably with some fat in it)

• Used almost exclusively to “boost” the effectiveness of other PIs• Possible side effects*: alcohol intolerance, diarrhea, dizziness, gas, headache, increases in triglycerides and cholesterol,nausea, neuropathy, stomach pain, taste alteration, vomiting, weakness, weight loss

• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor), requiring dose adjustment• Possible side effects*: diarrhea (common), gas, nausea, rash, upset stomach, weakness

• Must be taken with Norvir• Use with caution if you have liver problems or are allergic to sulfa drugs• May interact with a number of non-HIV meds and supplements, including some statins, birth control pills, male sexual enhancement drugs and allergy nasal sprays• Possible side effects*: diarrhea, headache, nausea, rash, stomach pain

• Should only be taken by people who have “CCR5-tropic” HIV (as determined by a tropism test)• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor)• Possible side effects: cold-like symptoms, dizziness, liver problems (may include yellow eyes/skin), muscle/joint pain, rash, stomach pain

• Use with caution if you also have hepatitis B or C• May interact with rifampin, a tuberculosis drug• Possible side effects: diarrhea, dizziness, elevated liver enzymes, fatigue, fever, headache, nausea, muscle pain/tenderness/weakness, rash, stomach pain, vomiting


• Must be boosted with Norvir when taken with Viread or Truvada• Only PI that doesn’t appear to increase cholesterol/triglycerides• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor), requiring dose adjustment• Possible side effects*: dizziness, elevated liver enzymes, kidney stones, lightheadedness, yellow eyes/skin, rash

• Needs to be taken with Norvir if you use the once-daily dose; don’t take with Kaletra• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor), requiring dose adjustment• Use with caution if you have hepatitis B or C, or are allergic to sulfa drugs• Possible side effects*: diarrhea, fatigue, headache, nausea, rash, stomach pain, vomiting

• Don’t take with Lexiva; don’t take with Norvir as a separate pill• May interact with a number of HIV meds, non-HIV meds and supplements (check with your doctor), requiring dose adjustment• Possible side effects*: diarrhea (common; may be severe), headache, increased liver enzymes, muscle weakness, nausea, rash, stomach pain, vomiting; once-daily dose may increase risk of some of these side effects

HIV Treatment and WomenThe single most significant fact that separates HIV-positive women from HIV-positive men is that more than 60 percent of women take care of at least one child under the age of 16. These women regularly have to put their children first, which means that they often can’t make doctor’s appointments or take their medications as prescribed.

That’s why it is critical that HIV-positive women have access to services that provide not only expert HIV care, but also a social worker or case manager and specialized gynecologic and obstetric services. If you are a woman with HIV, ask your doctor about getting vouchers for babysitting and discuss any problems you have taking medications. Unfortunately, there have not been many studies focused on women‘s responses to HIV treatment. Doctors do know, however, that many women with HIV experience changes in menstrual periods, more severe cases of gynecological problems, and decreased sexual interest. If you notice any of these changes, let your doctor know.

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Special Considerations ...Special Considerations ...

Last but not least, too many women with HIV feel isolated. Want to connect with others? Call your local AIDS organization and get the support you need.

HIV Treatment for People Coinfected With HepatitisMany people with HIV also have hepatitis B or C. Some researchers say having both diseases may make your HIV or hepatitis (or both) worse, but research on this is still continuing. One thing that everyone agrees on is that the higher your T-cell count, the better your response to hepatitis treatment is likely to be. Plus, some HIV medications—Viread and Epivir—also treat hepatitis B.

The best thing to do if you have hepatitis B or C is to go to a liver specialist (an infectious disease specialist, gastro-enterologist or hepatologist) who also specializes in HIV and hepatitis coinfection.

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HIV Treatment and PregnancyLots of HIV-positive women want to have children. The good news is that research has shown that pregnancy will not make HIV progress any faster in a woman who is generally in good health. The bad news is that there is no 100 percent guaranteed way to prevent an HIV-positive pregnant woman from passing HIV to her baby.

If an HIV-positive woman is not on any HIV treatment, there is about a 20 percent chance that her newborn baby will be infected. However, women can reduce the risk of infecting their babies to about 1 percent with the use of HIV medications and certain precautions. In addition, because there is HIV in the breast milk of infected mothers, HIV-positive women should not breast-feed their babies.

Many HIV medications appear to be safe for pregnant women. However, to avoid possible birth defects, pregnant women or women thinking of getting pregnant should not take Sustiva. Finally, to ensure the best for themselves and their babies, women with HIV should try to see an obstetrician who has experience treating someone who is HIV positive.

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ou and your doctor have reviewed all your options and you’ve made the big decision. Maybe your first few weeks

on treatment were rough because of some initial side effects. Maybe it’s been a cinch. What should you expect in the future? Your viral load should drop around 90 percent within eight weeks of beginning treatment and by six months it should ideally drop down to below 50 copies/mL (“undetectable”). Your T-cell count should go up, not down.

Remember that side effects are always possible and that the medications work differently for everyone. Tell your doctor about any symptoms you experience—even things that seem minor, like stomach problems, diarrhea, rash or weight loss. It’s important you report these problems because they may be a sign that the medications aren’t working properly in your body.

Generally, your doctor will check your viral load and T-cell count and do a general blood test three to eight weeks after you’ve begun therapy. If within three months of beginning treatment your viral load or T-cell count doesn’t change much, your doctor may suggest that you make a switch. If all is going fine, you’ll visit your doctor every three months and repeat these tests to make sure your treatment is still working.

The Ultimate Decision Is YoursHIV treatment has become complicated, and it’s difficult for even an expert to decide which combination of treatment will be successful for you. We hope this booklet has helped you better figure out your options. Don’t worry if it takes a while to understand. Keep your mind open, keep learning about HIV by visiting sites like The Body (www.TheBody.com), and don’t be afraid to ask your doctor lots of questions.

You’ve Started Treatment: What Now?You’ve Started Treatment: What Now?

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You’ve Started Treatment: What Now?You’ve Started Treatment: What Now?

n Preserve and restore your immune system.

n Maintain a viral load as low as possible—usually meaning keeping it undetectable.

n Minimize side effects and drug interactions, and avoid any permanent damage.

n Prolong your life and maintain your quality of life.

Remember the Goals of Treatment:

HIV therapy is still changing and new treatments, dosages and drug combinations become available all the time.

Keep in mind that hundreds of thousands of people in the United States are living with HIV and taking HIV medications. Most lead full and productive lives. Work with your doctor, become a partner in your care and get the support you may need by talking to others with HIV.

Always remember: You are not alone! Reach out to the many resources around you! Online or offline, there are lots of places you can go to stay connected to others, learn more about treatment, and keep up with the latest news. o

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