Are there any significant side effects of ART therapy?

Question

Hello doctor,

My cousin, who is 26, was diagnosed with HIV recently. He is starting antiretroviral therapy (ART) and is worried about the long-term side effects.

Can you explain what side effects he should look out for and how they might impact his day-to-day life?
Also, are there any advances in once-daily or long-acting injectable treatments he could consider to simplify his routine?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

ART (antiretroviral therapy) is a medical treatment that involves the use of a combination of antiretroviral drugs to suppress the replication of the human immunodeficiency virus (HIV) in the body. The common side effects of ART can be classified as:

Short-term side effects include nausea, vomiting, diarrhea, fatigue, headache, and mild rash.
Long-term side effects include:
1. Liver toxicity: Symptoms may include yellowing of the skin and eyes or abdominal pain.
2. Kidney issues: Some drugs, like Tenofovir disoproxil, may affect kidney function. Regular blood tests will monitor this.
3. Bone density loss: Long-term use of some ARTs can reduce bone density.
4. Metabolic changes include increases in cholesterol, fat redistribution (lipodystrophy), and insulin resistance.
5. Mental health changes: Anxiety, depression, or sleep disturbances may occur, particularly with integrase inhibitors.
The ways to manage side effects are:
1. 1. Regular monitoring and blood tests are essential to catch potential issues early.
  2. A balanced diet, exercise, and supplements (if recommended) can help with bone and metabolic health.
  3. If side effects are severe or persistent, switching medications is an option. ART regimens are highly customizable.
    
    The advances in HIV treatment are:
    1. Once-daily regimens: Most modern ART regimens are single-pill combinations taken once daily. Examples include Bictegravir, Emtricitabine, Tenofovir or Dolutegravir, and Lamivudine. They are effective, convenient, and have low rates of side effects.
    2. Long-acting injectable treatments: Recent advancements allow for less frequent dosing.
      1. Cabotegravir and Rilpivirine: This long-acting injectable is given once every one to two months. It eliminates the need for daily pills.
      2. Lenacapavir: A promising long-acting medication administered every six months (currently under development for broader use).
      However, he should ask his doctor about these options, as they may simplify his routine and reduce the stigma or burden of daily medication.
      
      Impact on day-to-day life: Once stable on ART, most people experience no significant disruptions in their daily lives.
      
      If he maintains an undetectable viral load (U=U: Undetectable = Untransmittable), he can live a healthy life, work, exercise, and even have children without transmitting the virus.
      
      Adherence to the treatment schedule is critical. Missing doses can lead to drug resistance.
      
      Kindly consult a physician, discuss with them, and start taking the medications with their consent.
      
      I hope this information will help you.
      
      Kindly revert in case of queries.
      
      Thank you.