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Medicines for AIDS - Antiretroviral therapy (ART)

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HealthWiki > A Health Handbook for Women with Disabilities > How to use the green pages > Medicines for AIDS


Medicines to treat AIDS are called antiretroviral medicines (ARVs). These medicines can help a person with AIDS live a longer and healthier life. Taken as a combination of at least 3 medicines, this is called AntiRetroviral Therapy, or ART. In this section you will find information about some common medicine combinations for ART. Look in the individual medicine charts to see if there is an interaction between your regular disability medicine and the medicines for AIDS.

HIV Care and ART Programs

HIV/AIDS is a complicated disease that affects every part of your body. As soon as you have a positive HIV test, try to find an HIV care program where trained health workers can see you regularly and help you stay healthy. HIV care programs can provide medicines to prevent and treat HIV illnesses, counseling and other support. They can help you start ART, treat any side effects, and change your ART if it is not working for you. Getting drugs from an ART program is more reliable and less costly than buying them from a private source.

When is ART needed?

People infected with HIV who still have healthy immune systems do not need ART. Only people who test positive for HIV and show signs of AIDS, or whose immune system is no longer working well, need ART. A blood test called a CD4 count can show how well the immune system is working. If this test is available, and your CD4 count is below 500, you and your health worker can decide when you should start ART. The goal is to start ART before HIV can damage your immune system.

Before starting ART, it is important to discuss with your health worker:

  • Have you ever taken any ARVs before? This may affect what medicines you should take now.
  • Do you have any illnesses or other conditions, like TB, serious infections, or fever? They may need to be treated first.
  • What are the benefits, risks, and possible side effects of ART? Try to talk to someone who is already using ART as well as your health worker.
  • Are you ready to take medicines every day, at the correct times? This is necessary for ART to work.
  • Will you have the support of a person you trust or an HIV/AIDS support group who you can turn to for information and help?

Be sure you know where to get help if you have problems getting your ART medicines, have problems with side effects, or need treatment for other health problems.

Do not start taking ARVs on your own. They may be the wrong ones for you and can have serious side effects.

Do not share ARVs with anyone, including a partner or child. Taking less than the recommended dose can cause the medicines to stop working, harming you and the person you share them with.

Do not buy ARVs from someone who is not part of an approved HIV care or ART program.

ARV combinations (ART regimens)

ARVs are effective only if they are taken in combinations (regimens) of at least 3 medicines. We list 4 common combinations in a table of ARV regimens, and then give more information about each medicine. As more is learned about HIV and how to slow or stop it, drug regimens will change. Ask your health worker what medicines are available and work best where you live.

The 4 regimens in the box below are the easiest to take. They can be taken with or without food. They are also the least costly and most available. Some combinations (all 3 medicines, or sometimes just 2 of the 3) are available in one pill, called a ‘fixed dose combination.’

How to Take ART

  • Whatever combination you use, take all 3 medicines every day, at the same times of day.
  • If the medicines need to be taken 2 times a day, there should be 12 hours between the 2 doses. For example, if you take the morning dose at 6:00, then the second dose should be taken at 6:00 in the evening. If you leave more than 12 hours between doses, having too little medicine in your body for some hours can cause drug resistance.
  • If you forget to take a dose on time, try to take it within 5 hours. If it is more than 5 hours late, wait until it is time for the next dose.
  • Do not stop taking any medicine that is part of an ART regimen without seeing a health worker to find out if your medicines should be stopped separately or all at once.

Side effects of ART

ART has helped many people live longer, healthier lives. But like many medicines, ARVs can have side effects for some people. Many people find that as their body gets used to the medicine, the side effects lessen and may go away completely. Some common side effects for ART are diarrhea, tiredness, headaches, and stomach problems such as nausea, vomiting, stomach pain, or not feeling like eating. Even if you feel bad, keep taking all your medicines until your health worker tells you to change or stop.

Some side effects are signs that the medicine needs to be changed. Serious side effects include tingling or burning feelings in the hands and feet, fever, rashes, yellow eyes, tiredness with shortness of breath, anemia and other blood problems, and liver problems. If you have serious side effects, see a health worker right away.

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ARV regimen for adults and adolescents (not for children)
d4T (stavudine), 30 mg + 3TC (lamivudine), 150 mg + NVP (nevirapine), 200 mg
These 3 medicines come combined in one pill called Triomune
or
d4T (stavudine), 30 mg + 3TC (lamivudine), 150 mg + EVF (efavirenz),
600 mg, one time a day
or
AZT (ZDV, zidovudine), 300 mg + 3TC (lamivudine), 150 mg + NVP (nevirapine), 200 mg
AZT and 3TC come combined in one pill called Combivir
or
AZT (ZDV, zidovudine), 300 mg + 3TC (lamivudine), 150 mg + EVF (efavirenz), 200 mg
AZT and 3TC come combined in one pill called Combivir 600 mg, one time a day


IMPORTANT!

Some ART medicines seem to cause more serious side effects than others. One of these is stavudine (d4T). The World Health Organization (WHO) recommends d4T-based treatment should be slowly phased out. In many countries, people with AIDS do not take stavudine any more. In other countries this is not always possible because there are no other medicines available or because other drugs are more expensive. If you have AIDS and you want to take ART medicines, talk with an experienced HIV/AIDS health worker in your community to see if other medicines are available.

HIV/AIDS Medicines

Pregnant women need to take special care

WARNING!
efavirenz (EFV, EFZ, Sustiva)

Efavirenz is an antiretroviral (ARV) medicine used in combination with other ARVs to treat AIDS.

Side effects
EFV may cause dizziness, confusion, mood changes, and strange dreams, but these will usually go away after a few weeks. If not, discuss with a health worker. Seek care immediately for yellow eyes or severe confusion.
Often comes in:
Capsules of 50, 100, 200 mg
Tablets of 600 mg
Oral solution of 150 mg/5 ml

How to use:
Take 600 mg, by mouth, one time a day.

Interactions with other medicines:
With rifampicin: the effectiveness of efavirenz is reduced. You may need to take a higher dose of EFV (800 mg instead of 600 mg).
Warning
Women in the first 3 months of pregnancy should not take EFV. It can cause birth defects. Women taking EFV who may become pregnant should use a reliable family planning method.
Lamivudine (3TC, Epivir)

Lamivudine is an antiretroviral (ARV) medicine used in combination with other ARVs to treat AIDS. It has very few side effects.

Often comes in:
Tablets of 150 mg
Oral solution of 50 mg/ 5 ml
How to use:
Take 150 mg, by mouth, 2 times a day.
nevirapine (NVP, Viramune)

Nevirapine is an antiviral (ARV) medicine used in combination with other ARVs to treat AIDS. NVP is also used to prevent mother-to-child transmission of HIV in pregnancy and during birth.

Side effects
Seek care immediately for yellow eyes, skin rash, fever, tiredness with shortness of breath, poor appetite.
Often comes in:
Tablets of 200mg
Oral suspension (liquid) of 50mg/5ml

How to use:
To reduce the chance of side effects when starting NVP as part of an ART regimen, take only a half dose for 2 weeks—200 mg of NVP once a day. After 2 weeks, take 200 mg of NVP 2 times a day.

Interactions with other medicines:
With rifampicin: may reduce the effectiveness of nevirapine.

Pregnant women need to take special care

WARNING!
stavudine (d4T, Zerit)

Stavudine is an antiretroviral (ARV) medicine used in combination with other ARVs to treat AIDS.

Side effects
Tingling, numbness, or burning feeling in the arms or legs. Seek care immediately for nausea, vomiting, severe abdominal pain, tiredness with shortness of breath, changes in body fat.
Often comes in:
Capsules of 15, 20, 30, 40 mg
Powder for oral solution of 5 mg/5 ml

How to use:
Take 30 mg 2 times a day.

Warning
Pregnant women and women who are heavy should not take stavudine if other medicines are available. See the ARV chart and the note below it.
zidovudine (AZT, ZDV, Azidothymidine, Retrovir)

Zidovudine is an antiretroviral (ARV) medicine used in combination with other ARVs to treat AIDS. It is also used to prevent mother-to-child transmission of HIV in pregnancy and during birth.

Side effects
Tiredness and shortness of breath. Seek care immediately for pale skin or other signs of anemia
Often comes in:
Capsules of 100 or 250 mg
Tablets of 300 mg
Oral solution or syrup of 50 mg/5 ml
Solution for IV infusion injection of 10 mg/ml
in a 20 ml vial

How to use:
Take 300 mg 2 times a day

Interactions with other medicines:
With dapsone: may cause anemia
With valproic acid: the levels of zidovudine may increase and cause nausea, vomiting, and fatigue
With rifampicin: may reduce the effectiveness of the zidovudine