Wednesday, June 10, 2020

The ABCs of ARV - An Antiretroviral Drug Primer

By Ronald Bugarin


(From ART First Dose Chronicles, Illustration by TJ Gellada Monzon)

For newly diagnosed Persons Living with HIV (PLHIV), among their top concerns are the possible side effects that might come once they start treatment. These side effects may have an impact on their way of life, especially at work and their studies. In this article, we will try to tackle the different antiretroviral (ARV) drugs, their possible side effects, and how to handle these side effects so as not to affect the PLHIVs way of life.

Antiviral Drugs

Antiretroviral or ARV is an inhibitor drug that blocks HIV from attaching to cells of immunity specifically the CD4 cell (also known as T-cell or T helper cells) and prevents it from multiplying. It has to be taken daily to suppress HIV and prevent the decline of the body's natural defense caused by the virus .

Below are the various ARV drugs and the possible side effects that may occur upon taking said component:

ARV DRUG
FOR MONITORING
Abacavir (ABC)
Liver and renal function
Rashes

Nausea

Hyperacidity
Increase fluid intake; Drink antihistamine
Take ARV after eating; eat menthol candy
Drink ARV after eating
Efavirenz (EFV)
Total Cholesterol; Liver function
Nausea

Dizziness
Vivid dreams

Hot feeling
Muscle degeneration / Fat accumulation

Mood swings / Depressive disorders
Take ARV after eating; eat menthol candy
Increase fluid intake
ARV should be taken before going to sleep
Take a bath
Exercise and balanced diet


Consult Doctor right away
Lamivudine (3TC)
---
Hyperacidity
Neuropathy
Drink ARV after eating
Take Vitamin B complex
Lopinavir/Ritonavir (LPV/r) 
Total Cholesterol
Loose bowel movement
Muscle degeneration / Fat accumulation
Take loperamide
Exercise and balanced diet
Nevirapine (NVP)
Liver function
Rashes

Fever / Flu-like symptoms
Increase fluid intake; Drink antihistamine
Take a sponge bath and increase fluid intake
Rilpivirine (RPV)
Liver function
Rashes

Drug interactions with other medications (e.g. for GERD, TB) 
Increase fluid intake; Drink antihistamine
Consult Doctor right away
Tenofovir (TDF)
Creatinine
Kidney problems
Decreased bone mineral density
Hyperacidity
Increase fluid intake
Increase calcium / vitamin D intake
Drink ARV after eating
Zidovudine (AZT)
Complete Blood Count (CBC)
Anaemia
Nausea

Headache

Muscle degeneration / Fat accumulation
Take B12 Vitamins
Take ARV after eating; eat menthol candy
Increase fluid intake; Drink paracetamol
Exercise and balanced diet

ARV Combinations 

The recommended regimen of ARVs consists of three (3) component drugs as it is proven to be more effective compared to single or dual therapy.

Currently, the following are the ARV combinations being provided by our treatment centers:

COMBINATIONS
SCHEDULE
SPECIAL CONDITIONS
Lamivudine+Tenofovir+
Efavirenz 
(3TC+TDF+EFV)
LTE 
Once day at bedtime (every 24 hours) 
Tenofovir component not advisable if with kidney problems
Lamivudine/Zidovudine+
Efavirenz
(3TC/AZT+EFV)
LZ+E
Lamivudine & Zidovudine - twice a day (every 12 hours) 
Efavirenz - once a day at bedtime (every 24 hours)

Lamivudine/Zidovudine+
Nevirapine
(3TC/AZT+NVP)
LZ+N
Twice a day
(every 12 hours) 
If rashes and fever occur for the first 14 days upon taking, stop drinking Nevirapine and immediately do a follow-up consult
Lamivudine/Tenofovir+
Nevirapine
(3TC/TDF+NVP)
LT+N
Lamivudine & Tenofovir - once a day (every 24 hours) 
Nevirapine - twice a day
(every 12 hours) 
  • Tenofovir component not advisable if with kidney problems
  • If rashes and fever occur for the first 14 days upon taking, stop drinking Nevirapine and immediately do a follow-up consult
Lamivudine+Tenofovir+
Rilpivirine
(3TC+TDF+RPV)
LTR
Once a day (every 24 hours)

Lamivudine+Abacavir+
Efavirenz
(3TC+ABC+EFV)
L+A+E
Lamivudine & Efavirenz - once a day (every 24 hours)
Abacavir - twice a day
(every 12 hours) 
Abacavir component not recommended for those with pre-existing heart problems
Lamivudine+Abacavir+
Rilpivirine
(3TC+ABC+RPV)
L+ABC+R
Lamivudine & Rilpivirine - once a day
Abacavir - twice a day (every 12 hours) 
Abacavir component not recommended for those with pre-existing heart problems
Lamivudine/Tenofovir+
Lopinavir/Ritonavir 
(3TC/TDF+LPV/r)
LT+Alluvia
Lamivudine & Tenofovir - once a day (every 24 hours) 
Lopinavir/Ritonavir - twice a day
(every 12 hours) 

Lamivudine/Zidovudine+
Lopinavir/Ritonavir 
(3TC/AZT+LPV/r)
LZ+Alluvia
Twice a day
(every 12 hours) 


Managing ARV Treatment

The purpose of having ARV treatment for PLHIV is for them to achieve being Undetectable and eventually have a normal life despite their status. But this can only be achieved by consistent and adherent intake of their ARV.

It is important that the set schedule in taking the ARV should strictly be followed to ensure: 1) efficacy of the treatment, and 2) minimize its side effects. Change in the schedule of drinking ARV should be consulted with the medical team. It is recommended that an alarm be set preferably in the Client's mobile device to remind him daily of his time for drinking his ARV. Also, relating the time in drinking his ARV for something he does daily (e.g. sleeping at night, eating dinner, etc.) can help in reminding him of this schedule in drinking his ARV.

Any recurring side effects despite performing the suggested intervention should immediately be consulted with the treatment doctor. Scheduled follow-ups to the treatment center especially for viral load testing should be routinely done to ensure monitoring of the efficacy of the treatment.

And most important, PLHIV should monitor his ARV supply if he has enough for at least three (3) months. It is advised to have a refill if ARV supply is less than two (2) weeks worth. Despite the community quarantine in place, clients enrolled in LoveYourself Treatment Centers can now request for ARV refill at the convenience of their home via Xpress Refill. To sign up, just click this link: go.loveyourself.ph/xpressrefill.

For more information on HIV Treatment as well as Life Coaching Services, you may also visit LoveYourself Anglo, Welcome, Victoria by LoveYourself, LoveYourself White House, Lily by LoveYourself, and Hero by LoveYourself by setting an appointment via Booking.

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