Side effects of HIV treatment

Numerous anti-viral drugs, some in combined form, have been approved by the FDA for treatment of HIV, to reduce the viral load and prevent destruction of the immune system. These drugs must be given in combination. However, they are all associated with side effects. The primary method of treating the side effects is to make a change in the antiviral medications. Major side effects may include the following:
· Hepatotoxicity: Women, especially those who are pregnant; those with existing liver diseases, such as Hepatitis B or C; and those who use alcohol may be at higher risk for developing hepatotoxicity.
· Hyperglycemia: An increase in blood glucose levels by itself, or as part of diabetes mellitus, is a side effect of all protease inhibitors (PIs).
· Hyperlipidemia: An increase in the lipids in the blood, such as cholesterol and triglycerides, is a side effect of some protease inhibitors (PIs).
· Lactic Acidosis: Too much lactate in the blood and a low blood Ph (acidic) are side effects of mitochondrial toxicity, caused by of all nucleoside reverse transcriptase inhibitors (NRTIs).
· Lipodystrophy: Fat redistribution, a disturbance in the way the body produces, uses and stores fat, is a side effect of the concurrent use of nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs).
· Osteonecrosis, osteoporosis, osteopenia: Damage to the bones is a side effect of HIV and some of the damage is related to protease inhibitors (PIs).
· Skin rash: NNRTIs cause most skin rashes, with Viramune causing the most severe rashes. NRTIs can also cause skin rashes.

Risk Factors
Currently, people of color are being disproportionately affected by HIV. For example, African American women are only 12% of all of the women in the United States, but they represent 68.8% of all women infected with HIV. Although African American women are currently bearing the greatest effect of the disease, in 1985 white homosexual males were most at risk. Therefore, race neither predisposes nor does it protect an individual from HIV infection. We must look to factors, other than race, that predispose individuals to engage in "high risk behaviors" which increase the probability of HIV infection.
There are many risk factors associated with HIV infection. Some factors pose a higher risk of infection than others. There are also differences in rates of infection, related to age.
Estimated per-act risk for acquisition of HIV
Exposure route
Risk per 10,000 exposures to infected source
Blood transfusion 9,000
Needle-sharing injection-drug use 67
Receptive anal intercourse 50
Percutaneous needle stick 30
Receptive penile-vaginal intercourse 10
Insertive anal intercourse 6.5
Insertive penile-vaginal intercourse 5
Receptive oral intercourse 1
Insertive oral intercourse 0.5
Risk factors are related to the following:
Poverty/socioeconomic factors: Studies have shown that there is a direct correlation between poverty and rates of HIV. Because nearly 1 in 4 African American and 1 in 5 Hispanics live in poverty, this impacts the rate at which they become HIV infected. Additionally, people living in poverty often don't have direct access to adequate health care.
Youth: Young people continue to be at risk for HIV infection and are becoming HIV infected in increasing numbers. This risk is more pronounced for minority and ethnic youth in the US.
Heterosexual transmission: Heterosexual contact poses a significant risk for women, especially those of minority races or ethnicities.
Men having sex with other men (MSM): The risk factors and barriers to preventing HIV for young MSMs are different from heterosexual men. Factors include the stigma attached to homosexuality, and young mens' frequent reluctance to disclose their sexual orientation.
Sexually transmitted diseases: Individuals who are infected with STDs are three to five times more likely than non-infected individuals to acquire HIV, if exposed to the virus through sexual contact. In addition, if an HIV-infected individual is also infected with another STD, that person is 3 to 5 times more likely than other HIV-infected persons, to transmit HIV through sexual contact. In the United States, over 12 million people develop STDs each year, and most of these people are under age 25.

Homelessness/runaways: Young people who are homeless or runaways, often engage in substance abuse, which can increase the risk for HIV infection. They may exchange sex for drugs or money, believing this is their only chance of survival on the streets. Homelessness is not just a problem of young people. Studies indicate that between 3-20% of homeless people are infected with HIV, with some subgroups having much higher rates. Also, surveys have indicated that homeless rates for those with HIV/AIDS are increasing. Because people with HIV/AIDS often lose their jobs or are unable to work, many will become homeless at some point.
Substance abuse: Young people (18-24) who use alcohol, tobacco, or other drugs are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol. Substance abuse is also a risk factor for other age groups.
Unsafe medical practices/Needlestick injuries: Unsafe medical practices that can lead to HIV infection include:
· using improperly sterilized instruments,
· using HIV-contaminated blood in transfusions,
· using HIV contaminated organs in transplants,
· exposing open wounds to HIV infected blood,
· needlestick injuries, and
· exposure of mucous membranes, and even supposedly "intact" skin to HIV-contaminated blood.
Needlestick injuries are a major concern for people in the healthcare industry. While the risk for HIV transmission from needlestick is low, it is still a significant danger. A study of syringes used to administer medications to people with HIV showed 3.8% had detectable HIV RNA. Moreover, in a study of the viability of the virus in needles, viable HIV was found in 8% at 21 days, when the needles had been stored at room temperature.
HIV positive children becoming adults: Many children who were infected through perinatal transmission are now becoming young adults, and making decisions about sexual behavior.
Perinatal Transmission: The number of new perinatal infections each year has steadily declined since 1994. At that time, a zidovudine regimen given prenatally, intrapartum, and to the newborn, was shown to reduce the risk of mother-to-child transmission by two thirds. However, the CDC estimates that between 280-370 neonates continue to be infected every year. Of those infected, 40% were born to mothers whose HIV status at delivery was unknown. CDC recommends universal HIV testing of pregnant women and routine rapid HIV testing using the opt-out approach for all women in labor whose HIV status is unknown.
Severe mental illness: Adults with severe mental illness have been disproportionately affected by the HIV/AIDS epidemic. Studies have shown that the majority of adults with severe mental disorders are sexually active and many engage in high-risk behaviors, such as unprotected sex, multiple sexual partners, and IV drug use.
Older adults engaging in unsafe sex: With improvement in health care, and the availability of drugs like Viagra, many older adults are remaining sexually active. Some older males have contact with prostitutes, as well as multiple sexual partners. About 10% of those with AIDS are over age 55 and 1 in 25 cases of AIDS in the U.S. are people 65 years old and older.