ARV's in our lives[swiss].indd - Treatment Action Campaign

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62 Side effects ‘What we must know is that the drugs have side effects. We don’t deny that. But if you are being monitored by your doctor, things will go well. It is very important to notice everything that is going on in your life when you are taking the drugs so that you can go immediately to report it to the nurse or doctor. Then you and your nurse or doctor can decide what to do in order to stop that particular side effect. I took AZT and developed anaemia. I felt weak and tired all the time. My clinic helped me and I am still alive today.’ Matthew Damane ‘In October 2003 I had a CD4 count test. The results came back and my CD4 count was 143, and I was not shocked because I was expecting it to be as low as 10. So on the 1st November 2003 I started taking 3TC, d4T and Nevirapine. I was really scared of taking the ARVs because of the side effects that they might have caused; fortunately I didn’t have any side effects. Instead the sores I had healed, I became healthy and now I can do everything by myself.’ Nowethu Ngubo Everyone worries about side effects from any medicine and people experience side effects very differently. For some people they are very mild – or none at all like Nowethu told us. For others they can be very severe and may mean changing a drug – like Prudence, Zoliswa and Zackie who tell their stories below. But most people find within a few weeks of starting HIV treatment that side effects are reduced and therapy becomes an ordinary and manageable part of daily life. Remember: • Most side effects are usually mild and resolve within the first few days or weeks. • They can often be reduced with other medication that is easy to use. • Sometimes a drug can be changed but not usually for a minor side effect. • There is a small risk of more serious side effects, but routine monitoring from your doctor should pick these up. More information about these side effects is provided below. • Never stop taking an ARV that you think is causing a side effect. Rather discuss it with your doctor or nurse. Ask your doctor, nurse or HIV pharmacist about the side effects related to the drugs that you use. Ask how likely they are to occur. Ask how you can recognise them and report them at your clinic or hospital. Ask how many people stop treatment because of them (usually very few). Even rough estimates will give you a good idea of what is involved. Nausea (feeling sick), diarrhoea, dizziness and tiredness are the most common general side effects. These often become easier after the first few weeks. In very rare cases, nausea and tiredness can be very serious. This is why you should tell your clinic or hospital of any problems.
Ask your doctor or pharmacist for anti-nausea and diarrhoea medications when you first start therapy if you need them. If these medications aren’t effective, ask your clinic for stronger or more effective medicines. More serious side effects Liver toxicity: Nevirapine, Efavirenz ‘My first combination was Nevirapine and Combivir (AZT + 3TC)…Then I found out one day that my liver was not coping with the combination, in particular the Nevirapine. So it was stopped and they were doing liver tests and everything. While they were doing that I had to change the regimen to Kaletra and Combivir. It was quite difficult because I wasn’t sure what was going on and the doctors were trying to explain but I think I was too anxious to take it all in. But I was talking to a friend of mine a lot and then after I changed, Kaletra worked well with me and the whole combination was good.’ Prudence Mabele Although liver toxicity with Nevirapine (or less commonly Efavirenz) does not happen to everyone who takes Nevirapine, it can be very serious and life-threatening if it does occur. Less than 5% people have to change treatment for this reason, but because nevirapine is included in FDCs it is very important to know about these symptoms. If you have a rash with Nevirapine, it is important that you have a blood test to check whether your liver is being affected (called liver function tests or LFTs). LFTs check a range of liver enzymes. The one that will mostly be checked at government clinics/hospitals is ALT. If tests are not available, you can judge by symptoms, which include: • Feeling sick (nausea) or being sick (vomiting) • Poor appetite • If your eyes or skin look more yellow • Light-coloured stools or dark-coloured urine • Tenderness or swelling in your liver – your liver is just below your ribs on the right side of your body. If you have any of these symptoms, you should contact your doctor immediately. Liver toxicity usually occurs in the first six weeks of treatment, but can also occur later. If you also have hepatitis then the risk of liver toxicity is much higher, and another choice of drug, other than Nevirapine, would be more appropriate. Rash: Nevirapine, Efavirenz About 10–15% of people who use Nevirapine or Efavirenz get a low-level rash that is not serious, and about 5% people discontinue the drug because of this. However, 2–3% of people can be at risk of a much more serious rash, especially using Nevirapine. 63
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in our lives A handbook for people
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in our lives A handbook for people
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Contents Note to readers of this ha
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Note to readers of this handbook He
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Antiretroviral treatment as part of
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The Comprehensive Treatment Plan sa
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Sometimes I get angry because peopl
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Health, illness and our body’s de
Page 17 and 18:
If just a small part of the DNA is
Page 19 and 20: When natural barriers fail and germ
Page 21 and 22: Immune system is like the Bafana Ba
Page 23 and 24: Funguses Parasites • Cryptococcus
Page 25 and 26: are perfectly fine and can help us
Page 27 and 28: But this allows the HIV to make man
Page 29 and 30: necessarily using blood tests. This
Page 31 and 32: drinking alcohol, smoking can be ha
Page 33 and 34: experiences and get advice from oth
Page 35 and 36: Eating to maintain health Before do
Page 37 and 38: You especially need more food when
Page 39 and 40: Treatment to stop HIV replication (
Page 41 and 42: Antiretroviral medicines We already
Page 43 and 44: fights back and brings the levels d
Page 45 and 46: But remember, an undetectable viral
Page 47 and 48: We can use the example of dough to
Page 49 and 50: Pipeline drugs: Entry Inhibitors -
Page 51 and 52: ‘We are letting the public know t
Page 53 and 54: What drugs will I start with? As pa
Page 55 and 56: Other things to know about recommen
Page 57 and 58: New non-standard approaches Using t
Page 59 and 60: Trial results never show a 100% suc
Page 61 and 62: This means that all services and tr
Page 63 and 64: Missing one or two doses a week can
Page 65 and 66: You may be regularly taking them la
Page 67 and 68: Avoiding resistance is one of the m
Page 69: Then if we start to use ARVs and ou
Page 73 and 74: another drug if this is possible. A
Page 75 and 76: Lactic acidosis is a term for a dan
Page 77 and 78: If you get a very good response to
Page 79 and 80: Table 1: Serious side effects from
Page 81 and 82: Resistance doesn’t only happen wi
Page 83 and 84: Sexual health, family planning and
Page 85 and 86: If you do want to get pregnant and
Page 87 and 88: What else do I need to know? Access
Page 89 and 90: It is time to take risks and do thi
Page 91 and 92: Getting enough staff for health fac
Page 93 and 94: In the beginning, when you ask heal
Page 95 and 96: Antiretroviral therapy (ART): is th
Page 97 and 98: Directly Observed Treatment Short C
Page 99 and 100: Immune system: the body’s complic
Page 101 and 102: or numbness in the toes and fingers
Page 103 and 104: Symptom: any perceptible, subjectiv
Page 105 and 106: Key Annexures Table of all register
Page 107 and 108: 99 List of sites per province Numbe
Page 109 and 110: 101 31 Eastern Cape O.R. Tambo Lusi
Page 111 and 112: 103 66 Free State Xhariep District
Page 113 and 114: 105 102 Kwa Zulu Natal Ethekwini DB
Page 115 and 116: 107 144 Kwa Zulu Natal Amajuba DC25
Page 117 and 118: 109 181 Western Cape Metro Region P
Page 119 and 120: Treatment literacy materials you ca
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113 Useful contacts Office and Mana
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Ten things to remember 1. With Trea
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