Queaze, Sneeze, Yawn, and Runs
A little laundry list of possible side effects of the different HIV drug classes
by Enid Vázquez
As explained in the article “HIV and Your Immune System” (see page 17), there are five different drug classes on the market to treat the virus. Although there are possible side effects with each of the HIV medications, some of them are associated with the drug classes themselves.
An important thing to remember about drug side effects is … they may not occur! The majority of side effects are a possibility, not a guarantee. Also remember that side effects vary from person to person—what happens to one individual may not happen to another.
On the other hand, some drug side effects are common, while others are rare. Patients should mention any and all symptoms to their medical provider.
This article will provide an overview. See the Positively Aware Annual HIV Drug Guide (March/April 2009) for more extensive lists of each drug’s potential side effects.
It’s a good idea to review the drug label itself, the comprehensive information that comes with a medication (often as a folded-up piece of paper). It can also be found online under the drug’s name, for example, www.atripla.com. The label, which is written with technical language, every word approved by the U.S. Food and Drug Administration (FDA), is usually re-written in simpler terms and available under “patient information.”
Note: With the many improvements in HIV therapy over the years, not all drugs within a class are associated with the side effects of that group of medications.
Nucleoside analogs
The nucleosides were the first HIV drug class available in the pharmacy. They include Combivir (Epivir and Retrovir), Emtriva, Epivir, Epzicom (Epivir and Ziagen), Retrovir (zidovudine, or AZT), Trizivir (Epivir, Retrovir, and Ziagen), Truvada (Emtriva and Viread), Videx and Videx EC, Viread (actually a nucleotide analog, but often lumped in with the nucleosides), Zerit, and Ziagen.
Some of the nucleoside analog drugs (mostly the older ones) are associated with pancreatitis (inflammation of the pancreas); enlarged, fatty liver; and lactic acidosis. These are serious conditions. They are not seen with Viread, Epivir, and Emtriva, which are known to be very tolerable medications.
Non-nucleoside analogs
There are four non-nucleoside analog drugs: Sustiva (widely used), Rescriptor (rarely used), Viramune, and Intelence, the newest in this class.
Rash is associated with this class. That doesn’t sound bad, unless it becomes severe and disabling. In addition, Sustiva and Viramune are associated with serious side effects of their own. See the Drug Guide for specifics.
Protease inhibitors
The protease inhibitors (PIs) are the drug class that turned the epidemic around (although Sustiva matches or beats many of them for efficacy). The PIs are Aptivus, Crixivan, Invirase, Kaletra, Lexiva, Norvir, Prezista, Reyataz, and Viracept.
For a while, the PIs were thought to cause the body changes often seen with HIV therapy. Later, it was found that other HIV drugs were also associated with these changes. Today, with newer HIV medications, facial and body changes can usually be avoided.
The potential drug class side effects of PIs are increases in cholesterol and triglycerides (except possibly unboosted Reyataz—without Norvir); onset of new cases or worsening of diabetes; immune reconstitution inflammatory syndrome (IRIS, see page 40); and bleeding in hemophiliacs. In terms of changes in body fat, lipodystrophy remains on the list of potential class side effects.
Entry inhibitors
There are two different types of entry inhibitors on the market. Although not as widely prescribed, they can still be effective, especially for treatment-experienced individuals.
Fuzeon is a fusion inhibitor and the only injectable HIV drug. Fuzeon is associated with injection site reactions and pneumonia.
Selzentry is an oral CCR5 antagonist. The most common side effects of Selzentry include cough, fever, cold, rash, liver toxicity, and diarrhea.
Integrase inhibitor
There’s only one on the market, Isentress, a powerful drug known for its low risk of side effects. The ones that may occur with Isentress are diarrhea, nausea, headache, fever, fatigue, and lipodystrophy.
Combination drug: Atripla
Atripla, possibly the most widely prescribed HIV medication on the market, is made up of three drugs from two different classes. Atripla consists of Sustiva, Viread, and Emtriva. Its one pill, once-daily formula has been a huge boost to HIV treatment, and it is hoped that other antiviral medication classes will be combined into one drug in the future. Nausea, diarrhea, and rash are associated with Atripla, but also check the drug guide for each individual drug.
Other drugs
Remember that people with HIV may take other medications, especially if they have advanced disease. Those drugs come with their own potential side effects. Be sure to discuss all your medications with your doctor or other medical provider to make sure they’re compatible and to educate yourself about possible side effects.
