Meds toxicity... How bad?

[newbie76]

This question won't really have make any difference for me... I, like many others, need the meds to stay alive.

But what I would like to know is how toxic the meds are?

Is it comparable to taking antibiotics everyday for the damage it does to our organs (liver, kidneys, ...)? Or more?

Is there a difference between classes of meds or are they all more or less the same in terms of toxicity? Are 1st line tratments "easier" on our  body?

I would just like to enphasise that I am not trying to slag off the meds or anything... as I said I am very aware that without them I would probably be very close to death by now... I would just want to know a bit more on their effect, that's all!

Thank you.

[allanq]

It looks like you're doing pretty well on your regimen of Sustiva and Truvada. This is a pretty common and effective first-line regimen. (It's equivalent to Atripla in the U.S.)  At the rate your viral load has been decreasing, it looks like you're on track for an undetectable viral load in your next set of labs.

Are you thinking of switching meds or is your question mainly academic?

I'm not sure that it's a good idea to classify some meds as more toxic than others. Side effects vary greatly from person to person. For example, for some people, the psychological side effects of Sustiva are absolutely intolerable. Many others tolerate Sustiva with no problem. So some people would consider Sustiva as "toxic," but others wouldn't. For some people, Viracept and Kaletra cause severe diarrhea; others find that it is not a problem.

I can't think of any meds that are free of side effects. However, there are some that I would definitely avoid. In the nucleoside or "nuke" category, I would avoid Zerit and AZT because both of them are strongly associated with lipoatrophy (loss of fat in the face and arms and legs). Zerit also has a strong association with peripheral neuropathy. With both these side effects, it is difficult or impossible to reverse the damage once it is done. I am living with the side effects from these two drugs years after I stopped taking them.

Another thing to remember about side effects is that they often decrease after a couple of weeks, so it might pay to tough it out if you are having trouble when you first start a drug.

There are currently 25 HIV drugs from five different classes approved in the U.S. (I don't know how many are approved in the U.K.)  Even though a person might have intolerable side effects from one regimen, the odds are that he or she could do well on a different combination.

Allan

[newbie76]

Hello Allan and thank you for your reply.

My question was very general and academic, as you put it.

I am one of the fortunates that has close to no side effects, but my question was more aimed towards the "damage" such strong medicines will have on our bodies in the long run.

That is why I was asking about a comparison with antibiotics. Everyone knows that antibiotics aren't good for you, even though undisputedly they help resolve a large number of pathologies. But they kill off the good bacterias and the intestinal flora.

So what I was interested in was to know how "heavy" on our bodies the meds generally are.

[megasept]

I am one of the fortunates that has close to no side effects, but my question was more aimed towards the "damage" such strong medicines will have on our bodies in the long run...

So what I was interested in was to know how "heavy" on our bodies the meds generally are.

On Mutation: The concept of a HIV patient "using up" any # of available meds due to viral mutation, has become less of a "given" and more of a problem for a minority, "salvage" patients. Their virus has mutated until unresponsive to all the meds. Amazingly, many are currently reaching "undetectable" viral levels with the new integrase class drug, Raltegravir. Years ago, it was common to hear a MD say "Let's save the Protease for later", meaning saving our last/best defense for when our first line of defense fails. Protease Inhibitor "cocktails" are "yesterday's news". Every 5-10 years more each of us can stay alive, the chances for more effective available treatments increases. Even the very sick may benefit from medical breakthroughs.

On Toxicity: You ask a good hypothetical question...

HIV is a powerful virus. We can't treat it with aspirin, olive oil, fresh garlic, steamed tomatoes, skinless chicken, and multivitamins---all good things! The powerful ARV drugs available tend to be toxic. Taking antibiotics for 5 days must be very different than taking them for weeks, months, or longer. Taking any drug (other than aspirin), for years probably adversely affects critical organs, like heart and liver. For preventive reasons I was asked to go on an STI nearly seven years ago. When my VL tops 100k and/or my CD4s decline to 300, I'll start new ARV. Toxicity is more than a "quality of life issue". Since it is possible to live decades with HIV, the downside is there's a potentially long exposure of organs to toxicity from the meds. For this reason, most newly diagnosed might better wait instead of starting therapy immediately.

On Side Effects: We get a little sloppy here when we use "toxic" interchangeably with "side effects". If my heart of liver are damaged by long-term treatment, that's hardly comparable to diarrhea, Lipo, sleeplessness, gas, etc.---all common side effects from  meds. By delaying first treatments whenever possible (until steady #s reach: VL > 100k and/OR CD4 <300) we reduce the years critical organs are subject to damage by ARV toxicity. Side effects matter. But toxicity is more critical Take the least toxic ARV drugs, effective for you, when you need to---not sooner.

  -megasept

[aztecan]

On Mutation: The concept of a HIV patient "using up" any # of available meds due to viral mutation, has become less of a "given" and more of a problem for a minority, "salvage" patients. Their virus has mutated until unresponsive to all the meds.

I think this is being overly optimistic. The "new" meds are just that, new. We really have no idea what the long-term effects of the recently introduced meds will be. Researchers may guess or hope, but only time will tell.

Also, the problem of adherence, while less of an issue with the fewer daily doses now needed, still is among us and I would be very much surprised if this new generation of possies will be any more adherent than their older counterparts.

Because of this, I think it may be premature to consider mutation and resistance "more of a problem for a minority, 'salvage' patients."

On Toxicity: You ask a good hypothetical question...

HIV is a powerful virus. We can't treat it with aspirin, olive oil, fresh garlic, steamed tomatoes, skinless chicken, and multivitamins---all good things! The powerful ARV drugs available tend to be toxic. Taking antibiotics for 5 days must be very different than taking them for weeks, months, or longer. Taking any drug (other than aspirin), for years probably adversely affects critical organs, like heart and liver. For preventive reasons I was asked to go on an STI nearly seven years ago. When my VL tops 100k and/or my CD4s decline to 300, I'll start new ARV. Toxicity is more than a "quality of life issue". Since it is possible to live decades with HIV, the downside is there's a potentially long exposure of organs to toxicity from the meds. For this reason, most newly diagnosed might better wait instead of starting therapy immediately.
 -megasept

Actually, this is a decision best left to the individual and their doctor.

Toxicity of the meds is certainly an issue. But, the virus is also toxic to the body. It also causes problems, including lipoatrophy, even without the presense of the meds.

It also causes dementia and, once it reduces the immune system to a shadow of its former self, allows other diseases to blossom and grow.

So it is certainly a balancing act. Were I to consider taking an STI, to give my body a rest from the meds, I would not allow my CD4s to drop below 350, and possibly not below 400, before restarting meds.

HUGS,

Mark

[StrongGuy]

Meds are definitely improving with much fewer sides and what some people term "toxiciity." I look at each drug and see what we know from doctors observations and studies and take each drug as it's own seperate entity and build a personal knowledge base from that . I'd also second what Megasept said.

[Miss Philicia]

I keep seeing all of these references to "organ failure" etc. on various threads due to drug toxicity.  Can someone provide some, uh... actual links instead of making assertions here?

Thanks.