- Health A to Z
Participants
Brian A. Boyle MD, Richard Elion MD, Anthony Vavasis MD
Summary
The benefits of HIV treatments often come with side effects, some of them strong enough to keep people from taking their medications. Join Drs. Richard Elion and Brian Boyle as they discuss some of the side effects that HIV patients may encounter, and offer their advice on how to cope with them successfully.
Webcast Transcript
ANQUOINETTE CROSBY: Welcome to our webcast. I'm Anquoinette Crosby. Nucleoside reverse transcriptase inhibitors, or NRTIs, were the first class of drugs used for the treatment of HIV. They can be highly effective when combined with other therapies, but they also come with potential side effects.
Here with me to talk about these side effects and what can be done to reduce them is Dr. Richard Elion, a physician in private practice in Washington, D.C. Thank you, doctor, for joining us. Also joining us from New York is Dr. Brian Boyle, Assistant Professor of Medicine at Weill Cornell Medical College.
Dr. Elion, what are the NRTIs, and how do they work?
RICHARD ELION, MD: NRTI is an acronym for nucleoside reverse transcriptase inhibitors, and those are the first class of drugs used for HIV. What they do is they prevent the RNA to be transcribed into DNA.
ANQUOINETTE CROSBY: What are some of the general side effects of the NRTIs?
RICHARD ELION, MD: Some of the general side effects of the NRTIs are, in combination with proteases, they seem to cause some changes in body composition, lipoatrophy and lipodeposition. In other words, the loss of fat and the deposition of fat. There are also some specific side effects -- anemia, some weakness of muscles, some neuropathy, some pancreatitis that's been associated with some of them, and those make up the majority of the side effects.
ANQUOINETTE CROSBY: Dr. Boyle, can you tell us how the side effects have interfered with your patients' adherence to treatments?
BRIAN BOYLE, MD: The side effects patients commonly encounter vary a lot, depending on which particular medications they're on. For example, AZT, also known as Retrovir, may have a lot of fatigue, may have some muscle aches, headaches and other symptoms. So I think that to say overall which side effects patients are going to have with antiretrovirals is relatively difficult, because it's going to vary a lot depending upon the individual medication, depending on how the medications are put together, and depending on the individual patient. Different patients have different side effects, depending upon the medications that they're on.
ANQUOINETTE CROSBY: Dr. Elion, why are the side effects of these medications so important?
RICHARD ELION, MD: They're very important for a number of reasons. Number one, at the end of 12 to 13 months, anybody, any population taking HIV drugs, half the people fail. It's estimated that of the 50 percent who fail, perhaps as many as 70 or 80 percent of that group have failed because they just couldn't take the drugs. So clearly, if a drug is going to make a person not feel good or feel sick, they're not likely to take them. If you're taking a regimen twice a day and you miss one dose in one day, which is about a 95 percent rate. At that rate, below 95 percent, you can have as much as a 15 or 20 percent loss in efficacy. Therefore, adherence, being able to stay with this regimen is incredibly, fundamentally, cardinally important for success with these drugs.
The second reason side effects are very important is, we're trying to operate on a model that HIV is a long-term, treatable infection. If there is an incremental, small, step-by-step layering on of these side effects over time, if these drugs cause side effects, people won't be able to stay on them for years and years.
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