Does Everyone Experience Side Effects From Hiv Treatment
Its not inevitable to experience side effects. Plus:
- Most of the side effects caused by the anti-HIV drugs used today are mild.
- Many side effects lessen or go away with time.
- The risk of most side effects is low.
- Its usually possible to do something about side effects, including changing treatment.
Anti-HIV drugs can sometimes cause longer-term side effects. For example, some cause increases to cholesterol and other blood fats, or disturbances in the functioning of the liver or kidneys.
Lipodystrophy is a side effect of some of the older anti-HIV drugs. These drugs are now avoided as much as possible for long-term use.
Monitoring for these and other side effects is a part of routine HIV care in the UK.
Why Do Integrase Inhibitors Like Bictegravir Cause Weight Gain
As suggested in this research, improved gastrointestinal tolerability and less nausea may play a role with newer agents such as bictegravir or TAF. There may be other biological effects not yet identified, as well as this population may gain weight similar to the population at-large.
Researchers did not find an association between > 10% weight gain and metabolic effects such as elevated blood sugar or types 2 diabetes onset. Pre-existing obesity was not found to be a risk factor for weight gain in the meta-analysis.
Other studies have also found a risk of weight gain with integrase inhibitors with a median weight gain of between 1 kg and 4 kg over one to two years of follow-up.
Can Your Weight Affect Your Hiv Treatment
Early in the HIV/AIDS epidemic, people would often lose weight as a side effect of their anti-HIV drugs. Many of the drugs still cause bouts of , , and , which make it difficult to eat. The disease and the drugs also can leave you too tired to prepare meals.
Some people with HIV still experience significant weight loss. However, the number of people who are overweight or obese at the time of diagnosis and during the course of their infection has increased over the last 25 years. This is due, in part, to the rising rate of in the general population.
But people are also gaining weight throughout the course of their disease. Anti-HIV drugs have improved and many people with HIV are finding they can gain weight because they feel better.
In addition to the more well-known side effects of extra weightlike and diabetesextra weight can add specific health problems to people with HIV.
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Nutrient Deficiencies And Low Calorie Intake
HIV weight loss may be due to nutritional deficiencies or not taking in enough calories, which can happen as a result of:
- neurologic disease, which may affect food intake or perception of hunger
- food insecurity due to psychosocial or financial issues
- malabsorption of nutrients due to nausea or diarrhea
- problems with the mouth or OIs making it more difficult to chew or swallow
- gastrointestinal issues, which may affect the absorption of nutrients or make people feel full more quickly
How Is Biktary Used
Biktarvy, from Gilead, is an oral, 3-drug combination tablet used to treat immunodeficiency virus type 1 . It contains the integrase strand transfer inhibitor bictegravir 50 mg, along with 200 mg of emtricitabine and 25 mg of tenofovir alafenamide , both HIV-1 nucleoside analog reverse transcriptase inhibitors .
Biktarvy was FDA-approved in Feb. 2018 as a complete regimen for the treatment of HIV-1 infection in adults and children weighing at least 25 kg :
- who have no antiretroviral treatment history or,
- to replace the current antiretroviral regimen in those who are virologically-suppressed on a stable antiretroviral regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of Biktarvy.
Biktarvy is taken once a day, every day, with or without food.
Three integrase inhibitors are currently approved for use in the US for people living with HIV:
Elvitegravir as a single agent was discontinued from the U.S. market in 2016.
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In Thebodypro’s Top 10 Hiv Clinical Developments Of 2020
As 2020 draws to a close, we asked David Alain Wohl, M.D., a professor of medicine in the Division of Infectious Diseases at the University of North Carolina and a highly respected HIV clinician-researcher, to take stock of the year’s most momentous research developments and other critical events. In this exclusive series of articles, Wohl calls attention to 10 such developments that have tremendous short-term implications for our day-to-day efforts to improve HIV prevention, treatment, patient care, and policy in the U.S., and analyzes each development with his trademark wit and clinical savvy.
A top story in HIV medicine in 2019 was the excess weight gain experienced by some during HIV treatment with integrase inhibitors. These antiretrovirals had quickly become the special sauce of HIV therapy: They were potent, had a high resistance barrier, and were very well-tolerated.
Make that: Mostly very well-tolerated.
This year solidified much of what we first heard last year. Additional follow-up from the ADVANCE trial, a study of initial antiretroviral regimens conducted in South Africa, laid out the differential effects of HIV therapies on weight. It showed continued accumulation of kilograms for those randomized to dolutegravir , especially when combined with tenofovir alafenamide /emtricitabine , a.k.a. Descovy.
For Females Using Dovato
If youre able to become pregnant, your doctor will likely give you a pregnancy test before you start Dovato treatment. This is because Dovato can be harmful to a developing fetus.
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Weight Gain During Hiv Treatment: A Double
Weight gain and obesity are well-documented risk factors in the HIV-uninfected population for cardiometabolic conditions such as diabetes and CVD, in addition to premature mortality . Excess weight in cART-recipients may, however, be a double-edged sword. Overweight and obesity during HIV treatment increases the risk of developing diabetes and CVD , however greater weight has also been associated with more effective virological suppression, higher CD4+ counts, slower disease progression and decreased mortality . The question of how to best manage weight gain during HIV treatment is therefore challenging yet of great clinical relevance especially in the current climate of earlier and more prevalent cART-initiation, increasing overweight and obesity and growing burden of associated metabolic and cardiovascular disease in people living with HIV-infection. However, studies examining the effects of weight gain in HIV-infected cART-recipients on the risk of incident glucose disorders , CVD and mortality are currently limited. The literature reporting the relationship between interval weight or adiposity gain during cART and the risk of incident glucose disorders, CVD and mortality, was therefore reviewed. Most reports are from well-resourced nations with early access to cART and with high rates of obesity, unless stated otherwise.
Risk Factors For Any Weight Gain In Participants Initiating Art
Baseline CD4 cell count had the strongest association with weight gain in multivariate models participants with a baseline CD4 count of < 200/L gained on average 2.97 kg more than participants with baseline CD4 count 200/L . Furthermore, increases in CD4 cell count and weight over time were closely correlated . Higher baseline HIV RNA was associated with a mean 0.96 kg greater weight gain participants with symptomatic HIV or AIDS gained 0.51 kg more than those with asymptomatic HIV . Participants who did not inject drugs at baseline gained 1.41 kg more than those who did . Black race was associated with weight gain, with a mean 0.99 kg greater weight gain compared to participants of other races . Female sex, age < 50 years, and persons with baseline obesity had smaller but statistically significant correlations with weight gain .
Effect of sex and race on weight change in individuals initiating antiretroviral therapy. A, Least squares mean weight change over time, stratified by sex. *P< .05 vs the comparator. B, LSM weight change over time, stratified by race . *P< .05 vs the comparator. C, LSM weight change over time, stratified by both sex and race. *P< .05 for black females vs non-black females **P< .05 for black females vs non-black females and for black females vs black males. P values for these comparisons are found in Supplementary Table 3.
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Increase Vitamin And Mineral Intake
Vitamins and minerals are essential to keep healthy. They protect against opportunistic infection by ensuring that the lining of skin, lungs and gut remain healthy and that the immune system functions properly. Of special importance are vitamin A, vitamin C, vitamin E, certain B-group vitamins and minerals such as selenium, zinc and iron. A mixed diet as recommended in Chapter three should provide enough of these vitamins and minerals. Some background information on micronutrients, their nutritional role and food sources is provided in Annex 3.
Vitamin A is important to keep the lining of skin, lungs and gut healthy. Vitamin A deficiency increases the severity of diseases such as diarrhoea while infection will increase the loss of vitamin A from the body. Good vitamin A sources are dark green, yellow, orange and red vegetables and fruit. These include spinach, pumpkin, cassava leaves, green peppers, squash, carrots, amaranth, yellow peaches, apricots, papaya and mangoes. Vitamin A is also contained in red palm oil, yellow maize, orange and yellow sweet potatoes, egg yolks and liver.
Vitamin C helps to protect the body from infection and aids in recovery. It is found particularly in citrus fruits such as oranges, grapefruit, lemons and mandarins. Guavas, mangoes, tomatoes and potatoes are also good sources of vitamin C.
Vitamin E protects cells and aids resistance to infection. Foods containing vitamin E are green leafy vegetables, vegetable oils, peanuts and egg yolks.
Heart Disease And Diabetes
Being overweight also puts you at greater risk for heart disease, high blood pressure, and , which can become life-threatening conditions. When you have HIV, your risk for these conditions is greater to begin with, although researchers arent sure if this is because of your long-term exposure to the virus, the antiretroviral medication, or both.
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Can Dovato Be Used For Prep
No, the Food and Drug Administration hasnt approved Dovato to be used as PrEP. This stands for pre-exposure prophylaxis. PrEP is the use of a drug to prevent someone at high risk for HIV from contracting it. People considered to be high risk include those who share needles or have sex without a condom or other barrier method.
At this time, only two medications are FDA-approved as PrEP:
- emtricitabine/tenofovir disoproxil fumarate
- emtricitabine/tenofovir alafenamide
If you think PrEP might be helpful to you, talk with your doctor about which medication might be best.
Weight Gain And Pregnancy
It is normal to gain weight during pregnancy. Most women begin to lose some of this weight within a few months of having their baby. It is unclear if women who start HIV treatment during pregnancy gain more weight than other women. We dont know if women already on HIV treatment when they become pregnant gain more weight than other women.
If you have a high body weight and you plan to have a baby, you will be encouraged to lose weight before becoming pregnant. Losing weight before becoming pregnant will benefit you and your baby, reducing the risk of complications during pregnancy and at the time of birth. Women who are obese are at higher risk of developing diabetes or high blood pressure during pregnancy.
Dieting during pregnancy or while you are breastfeeding is not recommended.
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Why Do Some Newer Hiv Drugs Cause Weight Gain
Future research should examine how particular combinations of antiretrovirals contribute to weight gain, according to one expert.
Some of the newer antiretrovirals , in particular integrase inhibitors, have been associated with weight gain, aidsmap reports. Given this concerning finding, researchers should set their sights on understanding which particular combinations of ARVs are the biggest drivers of weight gain among people with HIV.
That is according to an address given by Andrew Hill, PhD, of the University of Liverpool at the 17th European AIDS Conference in Basel, Switzerland, this month.
To some degree, the weight gain seen after individuals start ARVs is a result of the return to health effect among individuals who started with a compromised immune system. However, it is clear that this is not the only factor, given how weight gain can differ based on which ARVs individuals take.
The integrase inhibitors dolutegravir and bictegravir are associated with the greatest weight gains. Dolutegravir is sold as a stand-alone pill under the brand name Tivicay and is included in Juluca, Dovato and Triumeq. Bictegravir is included in Biktarvy and is not approved as a stand-alone tablet.
Research has consistently indicated that TDF-containing regimens are associated with less weight gain compared with regimens containing Ziagen or the newer version of TDF, tenofovir alafenamide . Abacavir is included in Triumeq, Epzicom and Trizivir.
To read the aidsmap article, .
Surgeries Facial Fillers And Related Therapies
Liposuction can remove fat in some areas of the body. It has been used successfully with buffalo humps and lipomas. Standard surgery can be done for breast reduction, although the fat sometimes returns over time. Neither liposuction nor other surgical techniques can be used in the belly because of the high risk of bleeding.
To help fill out sunken cheeks and restore a fuller appearance to the face, a variety of facial fillers and other therapies have been used. Results have varied. In fact, some have serious drawbacks and possible complications, so it is important to choose carefully. These surgeries can be costly talk to you doctor to find out if there is any coverage for these surgeries in your region.
Two non-permanent facial fillers available in Canada are poly-L-lactic acid and calcium hydroxylapatite . Both require multiple injections into the areas of the face with fat loss. These fillers stimulate the production of collagen around the areas where it is injected. The collagen grows for several months after the injections, helping to fill the face out.
There are two other non-permanent fillers sometimes used for facial wasting. Hyaluronic acid is a substance that is a normal component of connective tissue. Synthetic forms of hyaluronic acid are injected into the face. The length of time the results last varies. Collagen has long been used as a treatment for facial wrinkles.
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How Long Does It Take To Work
Dovato begins working in your body right away to treat your HIV. But it may take time to decrease your viral load.
In clinical trials, people took either:
- Dovato, which includes two drugs: dolutegravir and lamivudine
- dolutegravir and tenofovir disoproxil fumarate/emtricitabine
After 4 weeks, 70% of people in both groups had a viral load so low that it couldnt be detected. The lower your viral load, the fewer symptoms of HIV youre likely to have.
Here are answers to some frequently asked questions about Dovato.
Why Do Hiv Drugs Cause Weight Gain
Weight gain is a common side effect of antiretroviral therapy . On average, people put on about 4 pounds during the first 2 years of their treatment. Most of that gain happens in the first year.
About 1 in 5 people who were at a healthy weight when they were diagnosed with HIV become overweight within 3 years after going on these drugs.
Scientists aren’t sure why HIV medications cause weight gain. One possible reason is that they work. When you have HIV, your body constantly burns calories fighting infections. ART stops you from getting infections.
HIV treatment also helps you keep your appetite. And it helps your body absorb more of the nutrients from the foods you eat.
Your lifestyle also affects your weight. A high-calorie, high-fat diet and too little exercise could cause you to gain more weight while you’re on treatment.
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Hiv Drugs Weight Gain And Weight Loss
Several studies have found that people starting modern anti-HIV medications in recent years have put on weight. Given that weight gain seems to be associated with some medications more than others, it is often assumed that weight gain is a side effect of these drugs.
However, some research suggests that it may be that other anti-HIV medications actually suppress weight gain or even lead to weight loss. These medications tend to be older ones, whereas the drugs apparently associated with weight gain were more recently introduced.
If some older drugs do have the side effect of suppressing weight gain, this might explain why people starting HIV treatment in recent years have put on more weight than people who began several years ago. It might also explain why some people who have changed medications recently have put on weight.
One medication which may suppress weight gain is efavirenz. In recent years, its place in HIV treatment regimens has increasingly been taken by dolutegravir and other integrase inhibitors drugs which are associated with weight gain.
Another medication which may suppress weight gain is tenofovir disoproxil fumarate . While it is included in many one-pill-a-day HIV treatments, there are many alternative tablets which contain tenofovir alafenamide instead. Weight gain has also been seen in people taking TAF, especially people taking TAF and an integrase inhibitor together.
Preventing Weight Loss With Hiv
A healthy, nutritious diet is important in helping to prevent unwanted weight loss with HIV. People with HIV may need a diet that is higher in calories and protein than people without HIV. This can help prevent the loss of muscle mass.
People may want to add the following foods to their meals to increase protein intake:
The following tips may also help people to improve appetite and prevent unwanted weight loss while living with HIV:
- doing resistance and weight lifting exercise to build and maintain muscle mass
- making food enjoyable and tasty to eat
- eating smaller meals more frequently throughout the day, rather than larger ones
- drinking high-calorie protein shakes between meals
- avoiding citrus, spicy, or very hot or cold foods if the mouth is sore
- eating bland foods for an upset stomach
People may also want to work alongside their care team to work out a diet and exercise regime to maintain a healthy weight.
Treatment for HIV weight loss may include the following:
- appetite stimulant medication
- anabolic agents, such as testosterone or human growth hormone, to increase weight gain
- anti-nausea medication
- cytokine production modulators, such as thalidomide, but only in rare cases due to side effects
If a medical professional suspects HIV medications are causing unwanted weight loss or gain, they may suggest a change in medication.
If people have lipodystrophy, they can discuss treatment options with a doctor. Treatments for this may include:
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