NO SIDES, PLEASE

KNOW YOUR SIDE EFFECTS AND COMORBIDITIES

PEOPLE LIVING WITH HIV MAY EXPERIENCE MEDICATION SIDE EFFECTS — AND COMORBIDITIES, THE SIMULTANEOUS PRESENCE OF AT LEAST TWO DISEASES. HERE’S WHAT THE MOST COMMON ARE AND HOW TO TREAT

THEM. BY DIANE ANDERSON-MINSHALL

Side effect: diarrhea

how common: Extremely; in fact, diarrhea is among the most common reasons why people with HIV stop or switch their HIV meds. treatment: Three options: over-the-counter anti-diarrheal medicines such as Imodium (loperamide); Lomotil (diphenoxylate and atropine), which slows the gut to combat diarrhea and is commonly given to cancer patients; or Mytesi (crofelemer), the only Food and Drug Administration-approved drug to relieve noninfectious diarrhea in HIV-positive people. Derived from the red sap of the Croton lechleri plant, Mytesi is only the second botanical prescription drug approved by the FDA.

Side effect: mood changes, including depression and anxiety

how common: According to a 2019 study published in International Journal of Environmental Research and Public Health, 39 percent of people living with HIV were currently experiencing depression. AIDS Beacon previously reported that 63 percent of HIVpositive participants “reported symptoms of depression currently or at some point in the past. Overall, 26 percent of patients reported having had thoughts of suicide and 13 percent of participants reported having attempted suicide in their lifetimes.” treatment options: Selective serotonin reuptake inhibitors (SSRIs) are most effective. According to the National Institutes of Health, medications that have shown efficacy in treating depression in patients with HIV include (generic names) imipramine, desipramine, nortriptyline, amitriptyline, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, nefazodone, trazodone, bupropion, and mirtazapine. Side effect: hypertension/ high blood pressure

how common: Very. The U.S. Department of Veterans Affairs, for example, reports that 45 percent of its patients with HIV also have a hypertension diagnosis. A report from last year found that a quarter of all people with HIV also have hypertension, with the comorbidity most prevalent in North America and Western Europe. A 2018 review of findings, published in Hypertension, suggests that chronic inflammation associated with HIV and antiretroviral therapy is a major factor in the high rates of hypertension. treatment: Stop smoking. Medications include vasodilators (hydralazine), antihypertensives (Cozaar, Avapro, Diovan), ACE inhibitors (Prinivil, Lotensin), calcium channel blockers (Norvasc, Procardia, Plendil), and diuretics (Microzide, Diuril, Zestoretic).

Comorbidity: osteoporosis and osteopenia

how common: Osteopenia and osteoporosis are both forms of bone density loss, with the latter being more severe. Far more people with HIV have osteopenia (60 percent) versus osteoporosis (10-15 percent). The lower your body weight, the more susceptible you are to both. Fracture injuries are more common in young poz people because of it. treatment: Bisphosphonate therapy with vitamin D and calcium supplementation and medications including Fosamax, Boniva, Actonel, Atelvia, and Reclast. And just this year, a study presented at the virtual Conference on Retroviruses and Opportunistic Infections indicated that a “short course of alendronate” (the generic term for Fosamax and Binosto) at the beginning of tenofovir-based antiretroviral therapy can help prevent bone loss.

Comorbidity: cardiovascular disease

how common: It’s the second leading cause of death among people living with HIV. treatment: It may include a variety of approaches. There are cholesterol-lowering statin drugs such as Crestor, Lipitor, Zocor, Vytorin, Lescol, Mevacor, Altoprev, Livalo, Pravachol, Advicor, and Simlup. Programs that help you stop smoking, shed excess pounds, and exercise more are all useful. Reduce alcohol and sodium consumption. If your blood pressure is not in a healthy range, your doctor may prescribe medication. Among the options are ACE inhibitors (Vasotec, Prinivil, Zestril, Altace); angiotensin II receptor blockers (Cozaar, Atacand, Diovan); beta blockers (Lopressor, Toprol XL, Corgard, Tenormin); or calcium channel blockers (Norvasc, Cardizem, Dilacor XR, Adalat CC, Procardia).

Comorbidity: diabetes

how common: There’s a type of diabetes caused by pancreatic damage brought on by HIV medications. It’s less common than the other two types, Type 1 and Type 2, but equally damaging. treatment: Controlling blood sugar, medication, insulin treatment, and proper diet are the main treatments, with regular doctor screenings for easy-to-miss complications. Diabetes meds include Lantus, Januvia, Humalog, NovoRapid, Victoza, Farxiga, and about a dozen more.

MISSING IN ACTION

THE REDIRECTION OF RESEARCHERS AND RESOURCES TO COVID-19 — AND AWAY FROM HIV — COULD HAVE LASTING IMPACTS ON NEW TREATMENT

DEVELOPMENT. BY JACOB ANDERSON-MINSHALL

The COVID-19 pandemic and subsequent lockdowns have dramatically affected those who have HIV, many of whom struggled to maintain their treatment regimens during the crisis. While the impact on individuals has been tragic, the crisis has broader and potentially more damaging ramifications for the future of HIV treatment and prevention.

Kaiser Health News reports that the pandemic has disrupted “almost every aspect” of the battle against HIV, “grounding outreach teams, sharply curtailing testing, and diverting critical staff away from laboratories and medical centers.” That’s going to affect efforts to fight HIV for years to come.

Tiffany Chenneville, a psychology professor at the University of South Florida’s St. Petersburg campus says that the damage to mental health caused by the current crisis will also have ramifications on treatment and research.

Chenneville co-authored “The Impact of COVID-19 on HIV Treatment and Research: A Call to Action,” published last year in the International Journal of Environmental Research and Public Health. She notes some of her concerns have been confirmed. “HIV services have been disrupted and, in some places, HIV clinics have closed.”

Many, if not most, of the HIV drug trials and research efforts were simply shut down. Other researchers found that the pandemic could skew their results. In an article published in the Journal of the International AIDS Society last year, Peter F. Rebeiro, from Vanderbilt University School of Medicine’s Divisions of Infectious Diseases and Epidemiology, noted that not all participants could access telehealth visits, and that self-reporting may produce different results compared to third-party observations.

Rebeiro tells Plus that researchers may now need to factor in additional data. Did the participants have to change doctors, see someone via Zoom, or otherwise interrupt their routines? Scientists may also need to employ new resources (like electronic patient portals or secure texting) and integrate information about local health infrastructure and health-related policies into their reports.

In addition, he says, “We may need to reevaluate how we measure certain constructs like ‘engagement in care’ or ‘retention in care,’ as the data typically used to measure these may not be available for long periods of time, or because definitions based on frequency of in-person clinical contact may no longer meaningfully apply.”

The pandemic has brought some positives in the field of HIV treatment. Carl Dieffenbach from the National Institutes of Health summarized insights from this year’s Conference on Retroviruses and Opportunistic Infections, and noted that successful COVID-19 treatments and vaccine efforts could inform advances for HIV.

Dieffenback asked rhetorically, “Can we get to a longacting antibody that could either be used independent of a medication for the treatment or prevention of [HIV]?”

An antibody “cocktail” administered either as a pill or injectable could “allow people to live their truths of U=U [undetectable equals untransmittable] but not have to take a pill a day,” Dieffenbach explained.

The downstream impacts of the pandemic will continue to reverberate for years — or decades. It’s hard to say at this point whether the cumulative impact on HIV treatment will remain negative or spawn revolutionary breakthroughs.