HIV 5 - All about ARVs
Medicines used to treat HIV are called ANTIRETROVIRALS - ARVs for short. ARVs can’t cure HIV, but do help people with HIV live longer, healthier lives.1 Learn all about ARVS here.
How do ANTIRETROVIRALs work?
HIV attacks and destroys the cells in the immune system that are responsible for fighting infection, called the CD4 cells. The direct effect of us loosing these CD4 cells is that the body fails to fight off infections and certain cancers.1
ARVs are treatment for HIV with the aim of preventing HIV from multiplying in the body. This means that the amount of HIV in the body will be reduced, which is termed as 'reducing the viral load.1
When the viral load is low, the CD4 cells can recover and your immune system can start fighting off infections again! A low viral load also means that there is a lesser chance of spreading the virus to others.1
When do you start taking ARVs?
The benefits of ARV treatment far outweigh the risk of side effects - treatment prolongs life! Treatment keeps people living with HIV healthy + prevents the spread of HIV to others.
Taking medicines everyday, exactly as prescribed (called adherence) also reduces the risk of drug resistance.1
ARV side effects
Side effects are unwanted symptoms caused by medical treatment, also referred to as 'adverse effects'.
As with all medicines, side effects can occur.1
Side effects can range from mild to life-threatening and therefore it is difficult to identify the cause. It can be related to HIV treatment, other medicines or the disease (HIV) itself. Therefore, it is recommended that the patient continue with treatment if the side effects are mild.
These are the types of side-effects that can occur:
What does this mean?
Neural tube defects
Some ARVs can cause developmental defects in the foetus during the first six weeks of pregnancy. This is why family planning is recommended for all women who do not currently wish to become pregnant. For those women that do, they will be given a choice of which ARV is best for them.3
A group of ARVs are known to cause weight gain, this is important for patients who are overweight. These patients must receive lifestyle advice to help manage their weight, alternatively other ARVs should be given to patients who are obese.
Various types of ARVs can affect kidney function. It is therefore important to have kidney function tests performed prior to starting treatment.
Bone density (osteoporosis)
Being infected with HIV reduces bone density and ARVs contribute to bone loss.
This is due to a shortage of healthy red blood cells in the body to carry oxygen to organs and is common in patients with HIV as a result of their compromised immune system.5 Anaemia can be an indicator of an opportunistic infection or a side effect of some ARVs.3
This is the fat accumulation in the breast or back areas (‘buffalo hump’) or loss of fat under the skin, especially in the face.3,4
Some ARVs increase the risk of high levels of fat (cholesterol and triglycerides) in the blood.3,4
Gynaecomastia and lipomastia
Gynaecomastia (breast enlargement) may be due to benign glandular breast tissue proliferation or abnormal fat deposition (lipomastia), or both. It can occur in both males and females and can occur at any age. It is only caused by some ARVs with signs developing several months after starting the medication. It may be bilateral (both sides) or unilateral (only one breast implicated).3
All classes of ARVs have been associated with hepatotoxicity (liver damage) which presents as hepatitis. Symptoms include nausea, vomiting, loss of appetite, feeling weak or tired, fever, jaundice (yellow skin and eyes), dark-coloured urine, right-upper-quadrant pain and rash. Liver function tests will be done before and after a person starts ARVs.3,4,6
Skin and hypersensitivity reactions
Skin reactions (rash) are seen with the use of quite a few types of ARVs and can range in severity from mild to severe, often appearing within the first 6 weeks of starting treatment.3,4
A rash that occurs specifically to an ARV called, Abacavir can become life-threatening. If symptoms become worse with each dose, the patient will not be able to take this ARV in the regimen again.3
Can occur but usually resolves by itself.4
Immune Reconstitution Inflammatory Syndrome (IRIS)
This is a severe inflammatory reaction caused by starting ARVs when there is already an existing co-infection with TB, for example. The reaction makes the TB symptoms flare up. It is not normally a reason to stop ARVs.3
Support and counselling
People taking ARVs should be informed about the benefits of taking the medication and that side effects are usually manageable but also to know when to speak to a doctor.4
What are drug interactions?
This is when 2 or more medicines taken together ‘interact’ with each other in a way that is not useful, and often it means a person will have to have a change in their HIV regimen to ensure this doesn’t happen. A doctor will oversee all medicines that a person takes to ensure against potential drug interactions.1
There are many important drug interactions between ARV drugs and other medications, as well as between certain ARV drugs themselves.4
Potential drug interactions will be considered before an HIV regimen is recommended for you.3
Choice of HIV regimen
The choice of ARV regimen depends on a variety of factors, including health conditions that the person may have, contraception, and possible side effects of the medications.2
A HIV regimen will usually consist of a 3-drug combination.2 Medicines that are combined into one tablet are preferred as this reduces the number of tablets to be taken in one day. The most convenient and easy-to-take HIV regimen will be one that has the least number of pills taken once-a-day.4
General rules about treatment
Treatment for HIV is lifelong and the importance of taking medicines exactly as prescribed. People taking ARVs should know the benefits of treatment as well as the potential side effects relevant to the medicines that they use, including what to do and who to contact if serious side effects occur.4
Keep up a healthy lifestyle
HIV Treatment keeps HIV under control + benefits health + prevents transmission!3
- AIDSINFO, National Institutes for Health (NIH). HIV Treatment: The Basics [Last reviewed March 2, 2020]. Available from: https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/51/hiv-treatment--the-basics Last accessed August 2020.
- National Institutes for Allergy and Infectious Diseases (NIAID), National Institutes for Health (NIH). Starting and Staying on Antiretroviral treatment [November 27, 2018]. Available from: https://www.niaid.nih.gov/diseases-conditions/starting-antiretroviral-treatment Last accessed August 2020.
- National Consolidated Guidelines for the management of HIV in adults, adolescents, children and infants and prevention of mother-to-child transmission. South African National Department of Health, February 2020.
- Meintjes G, Moorhouse MA, Carmona S, et al. Adult antiretroviral therapy guidelines 2017. S Afr J HIV Med 2017;18(1):a776. https://doi.org/10.4102/ sajhivmed.v18i1.776.
- Hughson G. Blood problems and HIV. Aidsmap. [Online; November 2017]. Available at https://www.aidsmap.com/about-hiv/blood-problems-and-hiv Last accessed November 2020.
- NIH.gov. HIV and Hepatotoxicity. Side Effects of HIV Medicines [Last reviewed September 24, 2020]. Available at https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-hepatotoxicity Last acce3ssed November 2020.