Dr. Eva-Maria Seither, ContributorMANY OF you would have heard about the changing face of HIV. No longer is a positive test for HIV a death sentence. With medication and a healthy lifestyle, the virus can be effectively managed much like any other chronic condition. Nonetheless, as I mentioned in another column a few months ago, there are side effects to taking HIV medication. Today I look at some of the major ones and how they might be dealt with.
KIDNEY PROBLEMS
Kidney problems are not seen very frequently with antiretrovirals, but they may occur in patients taking Indinavir as part of their antiretroviral therapy (ART). Indinavir crystals can form in the kidneys and then cause a renal colic with severe back or side pain, radiating into the groin and testes for males. This can be treated with medications, but is best avoided by telling the patient to drink at least 1.5 litres of water and other fluids every day.
LIVER WOES
Some drugs used in ART can impair the function of the liver. Nevirapine is the one most frequently implicated in liver problems. People who suffer from hepatitis, an inflammation of the liver, are at a higher risk of experiencing ART side effects involving the liver. Your doctor would normally check liver function through a blood test before starting you on antiretroviral therapy.
Liver function checks should be done every few weeks, especially during the first months of treatment. If these checks show only mild liver problems, usually treatment can be continued. However, if liver function tests show elevated enzyme levels, treatment may have to be changed. Of course, alcohol and other drugs that can adversely affect the liver should be avoided.
LIPODYSTROPHY SYNDROME
This is something that sounds terribly big, but it really describes something very simple. Lipodystrophy syndrome is a redistribution of fat in the body. This is perhaps the most disliked, if frequent, side effect of being on ART.
What happens is that people affected by this lose the fat under the skin of the face, the arms and legs. The fat then sometimes is redistributed to the organs within the abdomen or to the abdomen itself. Persons who experience this side effect will look slim in the face and have skinny arms and legs but have a fat belly. Often this is really a cosmetic problem and most patients are able to deal with it without insisting on changing their treatment.
Sometimes, however, this redistribution of body fat is accompanied by increased levels of fat in the blood and an increase in blood sugar. Your doctor will from time to time repeat certain blood tests to monitor the blood sugar and the cholesterol levels and prescribe treatment as necessary.
The list of possible side effects could go on, but I shall stop here. The side effects listed above are the ones that we consider the most severe and the most frequently seen with antiretroviral medication. But side effects are common with taking many medications, so you shouldn't worry too much.
If when you open your medication packet and start reading the insert that comes with it and you see all the possible adverse effects, will that make you really feel like you don't want to take your medication at all? The question is: Are you going to experience all of these side effects if you start ART? The answer is clearly NO! Are you going to experience some of these side effects? Possibly, but maybe not.
We are all individuals and react differently to different things, including medication. It really is very important to discuss openly with your doctor your previous illnesses, for example, whether you have been anaemic in the past or whether you have had jaundice. Your doctor should decide with you which drug regimen will be best for you. Of course, possible severe side effects should be discussed, too, before you start treatment so that they can be recognised early and the appropriate action taken.
In the case of antiretroviral treatment, even if there are somewhat irritating and uncomfortable side effects, most of my patients understand that taking such
medication is what will make them better and make them live. The medication is really their lifeline. I've seen people with AIDS whom I thought wouldn't make it and when they started on antiretroviral therapy they made a complete turnaround. People who are now on antiretroviral medication are living very well, working, living their lives, able to look after their children and families. This is worth all the effort and this is what we aim for in every patient.
Dr. Eva-Maria Seither is a
volunteer physician with the
Montego Bay chapter of Jamaica AIDS Support. For comments or
questions please write to feedback@jamaicaaidssupport.com.
