Management of Side Effects

Christiane Schieferstein and Thomas Buhk

Patients on HAART commonly suffer from side effects. As a result, treatment of HIV infection has become a complicated balancing act between the benefits of durable HIV suppression and the risks of drug toxicity. About 25 % of patients stop therapy within the first year on HAART because of side effects (d'Arminio Mon-forte 2000). About the same number of patients does not take the recommended dosages of their medication due to concerns regarding the side effects ( Chesney 2000). Patients, who report significant side effects, are more often non-adherent to therapy (Ammassari 2001).

The patient should be counseled in detail about potential side effects, in order to be able to recognize them and to consult his physician in time. This can save lives, for example in the case of the abacavir hypersensitivity reaction, or prevent irreversible damage, such as polyneuropathy. Being prepared for the occurrence of possible problems and providing potential solutions improves both the acceptance of treatment and the adherence. However, patients should not be frightened by all this information - the extensive package inserts are often ominous enough. It may be difficult to distinguish between symptoms related to HIV infection and those caused by antiretroviral therapy. An accurate history, including any co-medication (not forgetting over-the-counter and "natural" products!) is paramount. It is important to consider the intensity, variation and reproducibility of complaints, as other possible causes should be excluded before symptoms are judged as being side effects of treatment.

It must be stressed that the majority of patients are able to tolerate HAART well, even over years. Nevertheless, the monitoring of treatment by an HIV clinician, is recommended in at least three-monthly intervals, even in asymptomatic patients, and more often at the beginning of a new HAART, when it should be weekly or fortnightly. Standard evaluations include a thorough history (allergies?, other side effects?), physical examination and measurement of vital signs and body weight. Routine investigations include a full blood count, liver, pancreas and renal function tests, electrolytes (plus phosphate in patients on tenofovir) as well as fasting cholesterol, triglycerides and glucose levels.

For lipodystrophy see chapter on "Lipodystrophy Syndrome".

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