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Here are a handful of common comorbidities and medication side effects that people living with HIV experience — and the most common treatment for each.
Side effect: changes in distribution of fat (lipodystrophy)
How common: According to AIDS Map, a 2001 study showed that 83 percent of people on certain antiretroviral drugs “experienced some symptoms of lipodystrophy after 21 months of therapy, while 11 percent experienced severe body fat changes.” Another study in France showed that 85 percent of people with HIV taking these drugs experienced at least one physical change during the first 18 months including “increased abdominal wall thickness, enlargement of veins in the legs and arms, increased waist size, and wasting of the lower limbs and/or buttocks.”
Treatment: Some options are injections of polylactic acid (New Fill, Sculptra) in face; liposuction to redistribute fat to other parts of the body; and RX of tesamorelin (Egrifta), which reduces excess belly fat in people who take HIV medicine.
Side effect: diarrhea
How common: Extremely; in fact, diarrhea is among the most common reasons why people with HIV stop or switch their HIV meds.
Treatment: Three options: over-the-counter anti-diarrheal medicines such as Imodium (loperamide); Lomotil (diphenoxylate and atropine), which slows the gut to combat diarrhea and is commonly given to cancer patients; or Mytesi, the only Food and Drug Administration-approved drug to relieve diarrhea in HIV-positive people. Derived from the red sap of the Croton lechleri plant, Mytesi is only the second botanical prescription drug approved by the FDA.
Side effect: mood changes, including depression and anxiety
How common: In one recent study, according to AIDS Beacon, 63 percent of HIV-positive participants “reported symptoms of depression currently or at some point in the past. Overall, 26 percent of patients reported having had thoughts of suicide and 13 percent of participants reported having attempted suicide in their lifetimes.”
Treatment options: Serotonin reuptake inhibitors (SSRIs) are most effective. According to the National Institute of Health, medications that have shown efficacy in treating depression in patients with HIV include (generic names) imipramine, desipramine, nortriptyline, amitriptyline, fluoxetine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxaine, nefazodone, trazodone, bupropion, and mirtazapine.
Comorbidity: osteoporosis and osteopenia
How common: Far more people with HIV have osteopenia (60 percent) versus osteoporosis (10-15 percent). The lower your body weight, the more susceptible you are to both. Fracture injuries are more common in young poz people because of it.
Treatment: Bisphosphonate therapy with vitamin D and calcium supplementation and medications including Fosamax, Boniva, Actonel, Atelvia, and Reclast.
Comorbidity: cardiovascular disease
How common: It’s the second leading cause of death among people living with HIV.
Treatment: A multi-prong approach may include a variety of treatments. There are cholesterol-lowering statin drugs such as Crestor, Lipitor, Zocor, Vytorin, Lescol, Mevacor, Altoprev, Livalo, Pravachol, Advicor, and Simlup. Programs that help you stop smoking, shed excess pounds, and exercise more are all useful. Reduce alcohol and sodium consumption. If your blood pressure is not in a healthy range, your doctor may prescribe medication. Among the options are ACE inhibitors (Vasotec, Prinivil, Zestril, and Altace); angiotensin II receptor blockers (Cozaar, Atacand and Diovan); beta blockers (Lopressor, Toprol XL, Corgard, and Tenormin); or calcium channel blockers (Norvasc, Cardizem, Dilacor XR, and Adalat CC, and Procardia).
Comorbidity: diabetes
How common: There’s a type of diabetes caused by pancreatic damage brought on by HIV medications. It’s less common than the other two types but equally damaging.
Treatment: Controlling blood sugar, medication, insulin treatment, and proper diet are the main treatments, with regular doctor screenings for easy-to-miss complications. Diabetes meds include Lantus, Januvia, Humalog, NovoRapid, Victoza, Farxiga, and about a dozen more.
Side effect: hypertension/high blood pressure
How common: Very. The U.S. Deptartment of Veterans Affairs, for example, reports that 45 percent of their patients with HIV also have a hypertension diagnosis. Nobody is sure why; whether it has to do with HIV itself, antiretroviral treatments, or a combination of factors.
Treatment: Stop smoking. Medications include vasodilators (Hydralazine), antihypertensives (Cozaar, Avapro, Diovan), ACE Inhibitors (Prinivil, Benazepril), channel blockers (Norvasc, Procardia, Plendil), diuretics (Microzide, Diuril, Zestoretic).
