Living with HIV (human immunodeficiency virus) It may be scary to find out that you re HIV-positive or have AIDS. Coping with this news may be difficult. Although HIV is a serious infection, people with HIV or AIDS are living longer, healthier lives. Several treatment options may slow the rate at which HIV weakens your immune system. Because it is important for you to learn as much as you can about HIV, we re providing you with this medication resource guide to help you live well with your condition. HIV and medications This booklet discusses current antiretroviral agents. It s not intended to guide treatment decisions or strategies. Decisions about when to initiate treatment, how many medications to use, when to change treatment, or whether a treatment change involves substitution or complete replacement of medications are very complex and need to be made with the advice of an HIV/AIDS experienced practitioner. You and your doctor will determine the best time to start treatment. When to take anti-hiv (also called antiretroviral) medications depends on your overall health, the amount of virus in your blood (viral load), and how well your immune system is working. In some situations, you may not need to take anti-hiv medications just because you re HIV-positive. Before starting anti-hiv medications, you, your doctor, and others on your health care team will consider four factors: your symptoms of advanced HIV disease your viral load your CD4 count your willingness to take the medications prescribed as they have been prescribed These four factors likely will change with time, so your clinician will want to check these labs and your health status regularly. Also, before you begin an HIV treatment regimen, there are several steps you can take to help you follow through with taking the medications: Talk with your doctor about your treatment regimen. Get a written copy of your treatment plan that lists each medication, when and how much to take, and if it must be taken with food or on an empty stomach. Understand the importance of adhering to the plan. Be honest about personal issues that may affect your adherence and speak candidly with your HIV care team about these issues. Sticking to a plan of treatment may be harder for people dealing with substance abuse or alcoholism, unstable housing, mental illness, or other life challenges (including financial issues). Develop a plan that works for you. Identify the activities you normally do at the times that you will be taking your medication. People who arrange their medication schedule around their daily routines follow through with their treatment plans better than those who do not. Consider a "dry run." Practice your treatment regimen using vitamins, jelly beans, or mints. This will help you determine ahead of time which doses might be difficult to take correctly. Some people with HIV are placed on one or more combinations of medications. On the following pages, you ll find a list of antiretroviral medications used to combat HIV, their description, possible side effects, and a schedule plan. You can write information about your medications and schedule on this form. You can select the of the medication you are taking, enter the number of pills you take at different times throughout the day, and add any notes that might be helpful to you in taking your medications or communicating with your health care team. Please note that the list of medications and their side effects is not exhaustive and each person is different. 2009, The Permanente Medical Group, Inc. All rights reserved. 1
Protease inhibitors (PIs) Protease inhibitors (PIs) are a class of anti-hiv drugs. Protease inhibitors prevent T-cells that have been infected with HIV from producing new copies of the virus. When one PI is used in combination with other anti-hiv drugs usually a total of at least 3 drugs then combination therapy can block the replication of HIV in a person's blood. Aptivus (tipranavir) Take with light meal or snack 250 mg diarrhea, stomach pain, tiredness, headache Crixivan (indinavir) Invirase (saquinavir) Kaletra (lopinavir plus ritonavir) No food two hours before or one hour after dosing, or with a light, low-fat snack Within 2 hours after a full meal With or without food 400 mg 500 mg 200/50 mg Kidney stones, nausea, vomiting, diarrhea, stomach discomfort, headache, insomnia, rash, back pain Nausea, diarrhea, stomach discomfort, insomnia, headache Diarrhea, nausea, feeling weak/tired Lexiva (fosamprenavir) 700 mg Rash, diarrhea, nausea, vomiting Norvir (ritonavir) With food if possible Refrigerate (especially in warmer weather or climates) 100 mg Prezista (darunavir) With a meal 600 mg Reyataz (atazanavir) Viracept (nelfinavir) Take with light meal Take with a meal or light snack 150 mg 300 mg 625 mg diarrhea, loss of appetite, stomach discomfort, oral tingling and numbness Diarrhea, nausea, headache, nasopharyngitis, rash Headache, pain/tingling in the arms and legs, nausea, diarrhea, rash Diarrhea, nausea, stomach discomfort, gas, rash 2009, The Permanente Medical Group, Inc. All rights reserved. 2
Nucleoside reverse transcriptase inhibitors (NRTIs) NRTIs are a class of anti-hiv drugs. When NRTIs are used in combination with other anti-hiv drugs usually a total of at least 3 drugs then combination therapy can block the replication of HIV in a person's blood. They are sometimes referred to as nucleoside analogues or "nukes" for short, and help prevent HIV from replicating into DNA that can then damage healthy lymphocytes (T-cells, or CD4/CD8 cells). Combivir (zidovudine plus lamivudine Emtriva (emtricitabine) Epivir (lamivudine) 150 mg 300 mg Epzicom (abacavir plus lamivudine Retrovir (zidovudine) [AZT] Trizivir (zidovudine plus lamivudine plus abacavir Truvada (tenofovir plus emtricitabine 100 mg 300 mg Viread (tenofovir) 300 mg Videx (didanosine) Take on empty 100 mg stomach, at least 30 minutes before or 2 hours after eating Videx EC (didanosine) Zerit (stavudine) [d4t] Empty stomach Avoid alcohol 125 mg 250 mg 400 mg 40 mg Ziagen (abacavir) 300 mg 600 mg Nausea, loss of appetite, headache, fatigue, stomach discomfort Headache, diarrhea, nausea, rash Nausea diarrhea, loss of appetite Nausea, stomach discomfort, headache, insomnia Fever, malaise, nausea, diarrhea, abdominal pain, sore throat, cough, shortness of breath, rash diarrhea, intestinal gas diarrhea, intestinal gas Numbness, tingling, pain in hands or feet, nausea, diarrhea, vomiting, headache, rash Numbness, tingling, pain in hands or feet, nausea, diarrhea, vomiting, headache, rash Numbness, tingling, pain in hands or feet, nausea, diarrhea, vomiting, headache, rash diarrhea, loss of appetite, insomnia 2009, The Permanente Medical Group, Inc. All rights reserved. 3
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) NNRTIs are a class of anti-hiv drugs. When one NNRTI is used in combination with other anti-hiv drugs usually a total of 3 drugs then combination therapy can block the replication of HIV in a person's blood. NNRTIs, sometimes referred to as nonnucleoside analogues or "non-nukes" for short, prevent healthy T-cells in the body from becoming infected with HIV. When HIV infects a cell in a person's body, it copies its own genetic code into the cell's DNA. By doing this, the cell is then "programmed" to create new copies of HIV. HIV's genetic material is in the form of RNA. In order for it to infect T-cells, it must first convert its RNA into DNA. HIV's reverse transcriptase enzyme is needed to perform this process. Reverse transcriptase is an enzyme that HIV brings along with itself so that the virus can use the nucleic acid in the CD4 cells it is infecting to change itself from an RNA virus to a DNA virus. NNRTIs attach themselves to reverse transcriptase and prevent the enzyme from converting RNA into DNA. In turn, HIV's genetic material cannot be incorporated into the healthy genetic material of the cell, thus preventing the cell from producing new virus. Edurant (Rilpivirine) With a meal 25 mg Rash, depression or mood swings, headache, vivid dreams Intelence (etravirine) With a meal 100 mg Rash, nausea, diarrhea, fatigue Rescriptor (delavirdine) Take at least 1 hour apart from buffered Videx (ddi) or antacids Sustiva (efavirenz) Take on empty stomach 600 mg Viramune (nevirapine) Rash, headache, fatigue, stomach upset Rash, vivid dreams, dizziness, confusion, insomnia, stomach discomfort Rash, stomach upset, headache, fatigue 2009, The Permanente Medical Group, Inc. All rights reserved. 4
Fusion inhibitors Entry (and fusion) inhibitors work by preventing HIV from entering healthy T-cells in the body. They work differently from many of the approved anti-hiv drugs the protease inhibitors (PIs), the nucleoside reverse transcriptase inhibitors (NRTIs), and the nonnucleoside reverse transcriptase inhibitors (NNRTIs), which are active against HIV after it has infected a T-cell. Entry inhibitors work by attaching themselves to proteins on the surface of T-cells or proteins on the surface of HIV. In order for HIV to bind to T-cells, the proteins on HIV's outer coat must bind to the proteins on the surface of T-cells. Entry inhibitors prevent this from happening. They still must be used, though, with other active anti-hiv drugs, usually in combinations of at least 3 drugs. Fuzeon (enfuvirtide) [T-20] 90 mg (1 ml solution) subcutaneous injection Pain, inflammation, bumps, itchiness, bruising 2009, The Permanente Medical Group, Inc. All rights reserved. 5
Full combination pills These are three drugs put into one combination pill that can possibly serve as your full regimen. However, in the United States, most patients cannot take these medications as their only treatment against HIV because the HIV in their body is already resistant to at least one part of the combination pill, rendering it ineffective. Consult with your clinician about potential resistance before starting any of these medications. Atripla (tenofovir plus emtricitabine plus efavirenz Empty stomach See above for all three of these drugs Complera (tenofovir plus emtricitabine plus rilpivirine With a meal See above for all three of these drugs Trizivir (zidovudine plus lamivudine plus abacavir See above for all three of these drugs 2009, The Permanente Medical Group, Inc. All rights reserved. 6
CCR5 antagonists CCR5 antagonists work by preventing HIV from attaching to the cells in your body. They block the virus from attaching to a coreceptor. If the virus cannot attach to the CCR5 co-receptor, it cannot get in and infect the cell. However, not all HIV needs CCR5 coreceptors to infect cells; in fact, most HIV-positive patients with advanced disease do not have virus that needs CCR5 co-receptors. Your doctor will order a test before prescribing CCR5 antagonists to make sure your virus needs CCR5 co-receptors to work (called CCR5 tropic ). The CCR5 antagonists still must be used, though, with other active anti-hiv drugs, usually in combinations of at least 3 drugs. Selzentry (maraviroc) 150 mg 300 mg Cough, fever, upper respiratory tract infections, rash, musculoskeletal symptoms, abdominal pain and dizziness 2009, The Permanente Medical Group, Inc. All rights reserved. 7
Integrase inhibitors Integrase inhibitors work by preventing HIV from being incorporated in the cell s nucleus They still must be used, though, with other active anti-hiv drugs, usually in combinations of at least 3 drugs. Isentress (raltegravir) 400 mg Nausea, headache, diarrhea, fever, muscle aches 2009, The Permanente Medical Group, Inc. All rights reserved. 8
Helpful terms AIDS: Acquired Immune Deficiency Syndrome. AIDS is the most severe form of HIV infection. HIV-infected patients are diagnosed with AIDS when their CD4 cell count falls (below 200 cells/mm3) or if they develop an AIDS-defining illness (an illness that is very unusual in someone who is not HIV-positive). Antiretroviral: A medication that interferes with replication of retroviruses. HIV is a retrovirus. CD4 count: CD4 cells, also called T-cells or CD4+ T-cells, are white blood cells that fight infection. HIV destroys CD4 cells, making it harder for your body to fight infections. A CD4 count is the number of CD4 cells in a sample of blood. Drug resistance: HIV can mutate (change form) while a person is taking anti-hiv medication. This may result in HIV that cannot be controlled with certain medications. Viral load: The amount of HIV in a sample of blood. References AIDSinfo, aidsinfo.nih.gov Kaiser Permanente (San Francisco) HIV/AIDS Medications Guide AIDSMeds.com, aidsmeds.com * This list of possible side effects may not be exhaustive. You should discuss possible side effects with your physician. Last updated: April 13, 2009 The information presented here is not intended to diagnose health problems or to take the place of information or medical care you receive from your physician or other medical professional. If you have persistent health problems, or if you have additional questions, please consult your physician or other medical professional. 2009, The Permanente Medical Group, Inc. All rights reserved. 9