Statistically speaking, around 80 per cent of all patients cope very well with their HIV therapy to get by. But what about the remaining 20 per cent? Axel Schock asked Berlin-based HIV specialist Gerd Klausen about the risks and side effects of HIV medication.
Thanks to effective medication, HIV infection is now just as manageable as diabetes or high blood pressure. However, like all tablets, HIV medication can also have unpleasant side effects. Before the HIV specialist provides information, Klaus (name changed) talks about his experiences.
"In the past four years, I haven't missed a single side effect listed on the package leaflet," says the 44-year-old with a slightly sarcastic tone and rattles off.
He talks about erection problems and severe insomnia; about days when he didn't dare leave the house because his bowels were going crazy. He was afraid of wetting his trousers. He reported pustules and skin irritations that made him look like a monster. They only gradually disappeared again after he changed his medication. "When I saw those young, agile, good-looking men in the advertising photos of the pharmaceutical companies in the gay magazines back then, I would have liked to vomit right away. The pills didn't make me happy, they made me feel really sick."
Dr Klausen, the decisive breakthrough in HIV therapy came in 1996 with the so-called combination therapy. Since then, three different antiretroviral drugs have always been used for treatment. But not every combination is equally well tolerated by all patients, is it?
Gerd Klausen: At the start of therapy, it is usual to check the effectiveness of the medication and how the organs are tolerating the medication, for example whether there are any changes in the liver and kidney values, as part of the close blood checks after four weeks.
On the other hand, there are side effects that the patient notices. These can be gastrointestinal problems such as diarrhoea and nausea, as well as sleep disorders, skin problems and effects on sexuality, i.e. a reduced libido. The aim is, of course, to find a combination for each patient that has as few side effects as possible, and ideally no side effects at all. This usually works, but not always at the first attempt.
How many combination options does the HIV patient have if he or she cannot tolerate one of the drugs?
That would be a good maths problem for the advanced maths course! There are currently 24 authorised active substances in Germany, which could theoretically be combined to form a large number of triple combinations. However, only three or four different drug combinations that have been really well studied are usually shortlisted for the start of therapy.
Does this mean that, in the worst case, I will have to put up with the side effects for the entire duration of the therapy?
Some side effects disappear a few weeks after starting to take the medication as soon as the body has got used to it. If this does not happen, it is worth considering whether it would be better to replace one or other of the active ingredients. The right combination is usually found within six months. However, the patient should definitely give themselves this time and not be too disappointed if side effects occur in the meantime. It is also important to realise that more frequent check-ups will be necessary during this period.
Is it possible that my HIV therapy with medication that I have to take for other medical conditions?
This problem of interactions between different medications can indeed exist and must be clarified by the doctor in each case. This also applies to the consumption of substances such as party drugs. It is therefore advisable to be open and honest with the doctor treating you so that he or she can take this into account when selecting HIV medication.
What happens if several of the HIV drugs are gradually no longer suitable for my treatment?
I am not really aware of any threatening restrictions in the choice of HIV medication, for example due to such interactions, in my everyday practice. The situation is somewhat different for patients who have been on treatment for many years and in whom resistance has developed over the course of treatment. Sometimes you really do come up against limits when you want to change the therapy.
HIV-positive people who have been on treatment for a very long time often not only have to deal with possible resistance to do. They also have to contend with the long-term effects of the medication. Will all HIV patients have to adjust to this sooner or later?
HIV doctors, especially those who have been working in this field for a very long time, are now very sensitised and aware of the long-term side effects. Especially as we now treat much earlier, i.e. more or less preventively. Namely at a time when the infection has not yet caused any serious damage. This makes it all the more important to avoid such long-term serious side effects.
Find out here, the consequential damage from which long-term therapy patients can suffer today.
