Fact Box - How to take antiretrovirals

AFRICA: Fact Box - How to take antiretrovirals

JOHANNESBURG, 1 Apr 2004 (PLUSNEWS) - South Africa's Gauteng province on Thursday began the distribution of free antiretroviral (ARV) drugs to HIV-positive patients qualifying for treatment.

Gauteng, South Africa's economic heartland, has the country's second worst HIV prevalence rate at 14.7 percent. Nationally, 4.5 million South Africans are living with the virus.

Gauteng provincial government aims to have 10,000 people on ARVs by the end of March 2005, providing a triple drug regimen of 3TC, Efavirenz and Stavudine.

What are these drugs and how do they work?

1. 3TC

This is an anti-AIDS drug that reduces the amount of HI virus in the body. 3TC is one of the nucleoside analogues, or nucleoside reverse transcriptase inhibitors, which assist in disrupting an HIV protein or enzyme called "reverse transcriptase", which is involved in making new viruses.

2. Efavirenz

Another anti-AIDS drug which reduces the amount of virus in the body by slowing down damage to the immune system. This is a non-nucleoside reverse transcriptase inhibitor, which acts by inhibiting the HI virus reverse transcriptase enzyme, but in a different way from the nucleoside analogue drugs like AZT, abacavir, d4T, 3TC, ddC and ddI.

3. Stavudine

Similar to 3TC, this drug belongs to the class of nucleoside analogue reverse transcriptase inhibitors. When taken with other HIV medicines, Stavudine can reduce the level of HI virus inside the body. Controlling the amount of HIV in your body is the best way for you to fight the onset of AIDS.

What are the known side-effects of each drug?

1. 3TC

Side-effects are most likely to occur during the early weeks of treatment. Side-effects of 3TC include: nausea, vomiting, diarrhoea, headaches, tiredness, abdominal pain, peripheral neuropathy (tingling and pain in the feet and hands) and insomnia. Your doctor can prescribe medicines to control nausea and diarrhoea before you start 3TC.

Discontinuation of 3TC may result in a flare-up of the Hepatitis B virus in HIV-positive people.

Less common side-effects of 3TC are neutropenia (low white blood cells) and a rash. Side-effects may be more severe among people with low CD4 counts. There have been reports of hair loss among people receiving 3TC, and a small number of reports of severe anaemia and lactic acidosis (a serious increase in levels of lactic acid in the blood). Pancreatitis has been reported in children.

2. Efavirenz

The most common side-effects of Efavirenz occur in the central nervous system (CNS), including: drowsiness or insomnia, dizziness, vivid dreams and nightmares, confusion, abnormal thinking, impaired concentration, amnesia (loss of memory), agitation, feeling "out-of-sorts" or "stoned", hallucinations, delusions, euphoria, and depression. Some of these side-effects are attributed to the impact Efavirenz has on sleep. Headaches and a mild rash may also occur.

The side-effects are most likely to occur in the first two weeks of treatment, but tend to diminish markedly after two weeks on treatment, although there is some evidence that symptoms like mild anxiety may persist while treatment continues.

3. Stavudine

Stavudine may cause numbness, tingling or pain in the hands or feet (neuropathy). This risk is increased in patients with advanced HIV or a history of neuropathy. If you are taking Stavudine in combination with other medicines that may cause similar side-effects, you may have a higher chance of developing these effects. Changes in body fat have been seen in some patients taking antiretroviral therapy. The cause and long-term effects are not known at this time.

Frequent side-effects reported in triple combination regimens containing Stavudine are nausea, headache, diarrhoea, rash, vomiting and neuropathy. During pregnancy Stavudine should only be used after discussion with your doctor.

How are these drugs prescribed and how do I take them?

It is important to take the drugs as prescribed, in order to maintain the right level of the drug in your bloodstream. If levels fall too low, this will help the development of resistance to these drugs and may also affect future treatment options.

1. 3TC

This drug can be taken once or twice daily. 3TC can be taken either with food or on an empty stomach.

2. Efavirenz

Efavirenz is dosed at 600mg, taken in the form of three 200mg capsules or one 600mg tablet once a day, with or without food, but high-fat meals may increase the absorption of Efavirenz, which may in turn increase the risk of side-effects, especially during the early weeks of treatment.

3. Stavudine

Stavudine comes in capsule form and can be taken with or without food. It is taken twice a day, and each dose should be taken 12 hours apart. Stavudine should be taken at the same time each day. If a dose is missed, it should be taken as soon as possible. If it is almost time to take the next scheduled dose, wait until then to avoid overdosing.



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