Patients on antiretroviral therapy have to be on medications for the rest of their lives. — Photos: AFP
Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are often mistakenly considered interchangeable terms, but they signify distinct aspects of a serious health condition.
HIV is a virus that targets and weakens the immune system, reducing the body’s ability to fight off infections.
In contrast, AIDS refers to the most advanced stage of HIV infection, and is characterised by severe immune system impairment.
According to Malaysia’s 2023 Global AIDS Monitoring: Country Progress Report, the nation reported 131,815 HIV cases and 30,174 AIDS cases from 1986 to 2022, with 3,177 new HIV infections reported in 2022 alone.
Once infected, an individual carries the HIV for life.
However, with consistent medical care and antiretroviral therapy (ART), the progression of HIV to AIDS can be effectively delayed or prevented.
As of December 2022, 47,067 people living with HIV (PLWH) were receiving ART, underscoring the critical role of early treatment and sustained healthcare support.
Antiretroviral therapy
ART regimen comprises a combination of at least three from several classes of antiretroviral medicines.
These medicines work by inhibiting the replication of the HIV’s deoxyribonucleic acid (DNA), effectively reducing the viral load in the body to undetectable levels.
As a result, the likelihood of PLWH transmitting the virus to others is substantially lowered and their overall quality of life is improved.
In addition, ART can help reduce the risk of opportunistic infections such as pneumonia, Salmonella infection, candidiasis, toxoplasmosis, and tuberculosis (TB), which HIV-infected patients often get.
In Malaysia, four classes of antiretroviral medicines are currently available.
These include nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs).
Patients on ART need to take the medicine lifelong, and it should not be discontinued except on the advice of a doctor.
To ensure its effectiveness, ART should be taken consistently at the same time every day, as non-compliance increases the risk of treatment failure.
However, some patients find it difficult to remain compliant with ART treatment because they experience adverse effects that affect their quality of life.
Thus, it is necessary to increase patients’ awareness of the potential adverse effects of ART medicines.
With improved awareness, patients are able to take action to reduce their likelihood and continue to adhere to their treatment plan.
Boiling tap water helps to kill off harmful microorganisms that could potentially infect HIV patients, whose immune systems are already weakened. — Photos: AFP
What to look out for
An example of the side effects of ART from the NRTI class is mitochondrial toxicity, which causes numbness and nerve pain in patients, and is commonly associated with tenofovir.
Tenofovir should be used with continuous monitoring of kidney function and regular bone mineral density tests, as it has also the potential to cause side effects related to both organs.
Other side effects of NRTIs are stomach discomfort, nausea, vomiting and diarrhoea.
Nevirapine, a medicine from the NNRTI class, can cause rashes that typically subside within two to four weeks.
However, in some cases, it may lead to a more severe reaction known as Stevens-Johnson syndrome.
It starts with flu-like symptoms, followed by a painful rash that spreads and blisters, which burst to leave painful sores.
Efavirenz, another medicine in the NNRTI class, is commonly associated with side effects such as headaches, difficulty sleeping, dizziness and insomnia.
Medicines from the PI class are often associated with hepatotoxicity and metabolic syndrome.
Meanwhile, INSTIs may cause side effects such as muscle pain, dizziness and insomnia.
Strategies for managing ART side effects
Patients on ART can take appropriate precautions to minimise the extent of expected side effects.
This is important as the side effects can affect the patient’s adherence to ART treatment.
Side effects of dizziness and headache can be tackled by taking painkillers such as paracetamol at the recommended dose and frequency.
Adequate rest also helps in this situation.
Patients are also advised to limit caffeinated drinks such as tea and coffee.
Patients who experience insomnia should practice healthy sleep habits.
For leg muscle pains, HIV patients can consider having a relaxing, warm foot bath. — dpa
This includes creating a conducive sleeping environment, such as a quiet, dark and comfortable room.
Gadgets and electronic equipment such as mobile phones, computers and televisions in the room should be turned off at least 30 minutes before bedtime.
Large amounts of food and alcoholic beverages or caffeine should also be avoided when approaching bedtime.
In addition, patients are advised to drink plain, boiled water and reduce the quantity of food or serving size for each meal.
These measures may reduce the side effects of vomiting and diarrhoea.
Patients should avoid spicy, fatty foods and get medical care immediately if they develop persistent diarrhoea or vomiting.
Rehydration salts and other medicines can be taken if required.
Rashes can be managed by applying moisturising skin products or fragrance-free soap to the affected areas.
Patients have to limit their time outdoors, particularly during hot weather, to avoid sun exposure to the skin.
Drinking plenty of water is also highly recommended.
As for the side effects of numbness or muscle pain in the legs, patients are advised to choose appropriate socks or shoes.
They should limit activities that require them to walk for long periods.
Patients can soak their feet in warm water and massage them with a cloth as a means of leg relaxation.
In addition, medicines such as paracetamol and non-steroidal anti-inflammatory medicines like diclofenac or mefenamic acid can help relieve muscle discomfort.
Adherence to the ART regimen is a critical factor in determining the effectiveness of treatment.
Taking steps to manage the side effects of ART can notably improve compliance.
Patients are encouraged to consult their doctors or pharmacists for proper guidance and advice on managing ART and its associated side effects.
For any inquiries regarding medicines, call the National Pharmacy Call Centre (NPCC) at 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.
Mohd Shahiri Abd Ghapar is a pharmacist with the Health Ministry’s Pharmacy Practice and Development Division. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
