Dealing with side effects

Like all medicines, the drugs used to treat HIV can cause side-effects. However:

• It is not inevitable that you will experience side-effects.
• Most of the side-effects caused by the anti-HIV drugs used today are mild.
• Many side-effects lessen or go away with time.
• How often a side-effect occurs varies, but for many side-effects the risk is quite (or very) low.
• It is almost always possible to do something about side-effects, including changing treatment.

Some side-effects are more common. These include:

• Diarrhoea.
• Feeling or being sick (nausea or vomiting).
• Headache.
• Tiredness.
• Rash.

If you are especially worried about a particular side-effect, you may want to talk to your HIV doctor about these concerns when you are deciding which anti-HIV drugs to take. It may be possible to select a combination of drugs that avoids the risk of the side-effect that you are worried about.

In most cases, these side-effects are worst in the first few weeks after treatment with a drug is started. They can often be controlled with other medications (for example, paracetamol for headache or Imodium for diarrhoea), and many people find that the side-effect lessens or goes away completely with time.

A widely used anti-HIV drug is called efavirenz (Sustiva; it is also in the combination pill, Atripla). Some people feel drowsy or dizzy, find they cannot concentrate, have changes in their mood including sadness or depression, or have sleep problems, when taking this drug. These side-effects are most likely to occur when treatment with the drug is first started. Often, they then lessen or go away. Some people find that they can reduce the problem by taking their medication two hours before going to bed, and by not taking the drug with fatty food.

Anti-HIV drugs can sometimes cause longer-term side-effects. For example, some cause increased cholesterol and other blood fats, or disturbances in the functioning of the liver. Lipodystrophy (body fat changes, such as losing some fat from your face, legs, arms or buttocks, or gaining fat elsewhere) is a side-effect of some of the older anti-HIV drugs. These drugs are now avoided as much as possible for long-term use.

You’ll be monitored for these and other side-effects as part of your routine HIV care.

Your HIV treatment is meant to improve your health, so it is important to remember that you do not have to put up with side-effects. It is nearly always possible to do something about them.

But for this to happen, it is important that your HIV doctor knows that you are experiencing problems. So it makes good sense to tell your doctor if side-effects are making your life difficult.

In rare cases, people can develop a serious allergic reaction to a drug. The anti-HIV drugs with the greatest risk of hypersensitivity, or allergy, are abacavir (Ziagen, also in the combination pills Kivexa and Trizivir), nevirapine (Viramune), etravirine (Intelence) and raltegravir (Isentress). You’ll be told about the sort of allergic reaction that might occur and what symptoms to look out for before you start treatment with the drug. Contact your HIV clinic immediately, or go to the Accident and Emergency department of your local hospital, if you develop any of these symptoms.

Although it may be tempting, do not stop taking your medication, skip doses, or reduce the number of pills that you take without first speaking to your doctor. You could develop resistance to several drugs that way. It’s better, with your doctor, to plan how you can safely switch to a different treatment.