Empowering Lives: Minimising the side effects of antiretroviral medicines

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are often used interchangeably, but both have different meanings.

HIV is a virus that attacks the immune system and weakens an individual's immunity to fight infection optimally. On the other hand, AIDS refers to the patient's experience of HIV infection in its final stage.

An infected individual will harbour the HIV virus for the duration of their life. Regular health appointments and antiretroviral medication can, nevertheless, prevent the progression of HIV infection to the AIDS phase.

The treatment for HIV is called antiretroviral therapy (ART).

What is ART?

An ART regimen is a combination of at least three types of medicines from several classes of antiretroviral medicines. To date, in Malaysia, there are four types of ART groups that have different mechanisms, namely, nucleoside/nucleotide reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), and integrase strand transfer inhibitors (INSTI).

The function of the ART is to increase the number of white blood cells (CD4 cells) as well as reduce the number of HIV viruses in the body (viral load). This can help reduce the likelihood of opportunistic infections, which HIV-infected patients often get. Next, the level of health and quality of life of the patient will increase.

Patients on ART need to take the medication lifelong, and it should not be discontinued except on the advice of a doctor. ART should be taken at the same time every day, as non-compliance is at risk of causing treatment failure.

However, because of the adverse effects that lower their quality of life, some patients find it difficult to remain compliant with ART treatment. Thus, it is necessary to increase patients' awareness of the potential adverse effects of ART medicines so they are able to take actions to reduce their likelihood and continue to adhere to their treatment plan.

Common side effects of the antiretroviral

Among the side effects of ART from the NRTI class such as tenofovir, is mitochondrial toxicity, which causes numbness and nerve pain. In addition, NRTI medications can also cause stomach discomfort, nausea, vomiting, and diarrhoea. Tenofovir in particular should be used with continuous monitoring of kidney function and regular bone mineral density tests, as this medication has the potential to cause side effects related to both organs.

Nevirapine from the NNRTI class can cause rashes that resolve on their own in two to four weeks. However, more serious Stevens-Johnson syndrome side effects can develop in some circumstances. Efavirenz, another medication in the NNRTI class, frequently results in headaches, trouble sleeping, dizziness, and insomnia.

Hepatotoxicity and metabolic syndrome are two common side effects of PI class medications. On the other hand, adverse effects from INSTI medicine include muscle pain, dizziness, and insomnia.

Strategies for managing the side effects of antiretroviral

Patients on ART medication can take appropriate precautions to lessen the effects of side effects. This is important as the side effects can affect the patient's adherence to ART treatment.

Side effects of dizziness and headaches can be overcome by taking painkillers such as paracetamol tablets according to the recommended dosage as well as frequency. Calm conditions and adequate rest in a quiet and dark room also help in this situation. Patients are also advised to reduce caffeinated drinks such as tea and coffee.

Patients who suffer from insomnia are encouraged to adopt healthy sleep habits. This includes creating a conducive sleeping environment, such as a quiet, dark, cool, and comfortable bedroom.

Gadgets and electronic equipment, such as mobile phones, computers, and televisions, in the room should be turned off at least 30 minutes before bedtime. Not only that, but large amounts of food and alcoholic beverages or caffeine should also be avoided when approaching bedtime.

In addition, patients are advised to always drink boiled plain water and reduce the quantity or serving size of food for each meal. These measures may reduce the side effects of vomiting and diarrhoea.

Furthermore, patients should avoid spicy, fatty foods, and get extra medical care if they have developed persistent diarrhoea or vomiting. Rehydration salts and other medications can be taken as prescribed.

By applying moisturising skin products or fragrance-free soap to the affected areas of the body, this may help reduce the side effects associated with the rash. Patients should limit their time outside, particularly during hot weather, to avoid sun exposure to the skin.

Drinking enough water is also highly advised.

As for the side effects of numbness or muscle pain in the legs, patients are advised to choose the appropriate socks or shoes. Limit activities that require the patient to walk for a long period of time.

In addition, the patient can soak his feet in warm water and massage them with a cloth as a means of leg relaxation. Besides, medications such as paracetamol and non-steroidal anti-inflammatory medications like diclofenac or mefenamic acid can help relieve muscle discomfort in other parts of the body.

The importance of effectively addressing side effects

Adherence to the ART regimen is one of the factors that determines the effectiveness of treatment. Therefore, the patient's adherence to the treatment should be emphasised, and one way is to minimise the possible side effects.

Patients are encouraged to talk to healthcare professionals, such as doctors or pharmacists, for appropriate guidance and advice so that the side effects of ART medication can be effectively managed.

If there are any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.

Prepared by Mohd Shahiri Abd Ghapar, Pharmacist at Pharmacy Practice and Development Division, Health Ministry.