AIDS Medications

Although there is no cure for acquired immunodeficiency syndrome (AIDS), medications have been highly effective in fighting HIV and its complications. Drug treatments help reduce the HIV virus in your body, keep your immune system as healthy as possible and decrease the complications you may develop. Some of the drugs approved by the FDA for treating HIV and AIDS are listed below.

Nucleoside Reverse Transcriptase Inhibitors (NRTI)

These drugs interrupt the virus from duplicating, which may slow the spread of HIV in the body. They include:

Abacavir (Ziagen, ABC) Didanosine (Videx, dideoxyinosine, ddI) Emtricitabine (Emtriva, FTC) Lamivudine (Epivir, 3TC) Stavudine (Zerit, d4T) Tenofovir (Viread, TDF) Zalcitabine (Hivid, ddC) Zidovudine (Retrovir, ZDV or AZT)

Combinations of NRTIs make it possible to take lower doses and maintain effectivenss. These drugs include Combivir (Zidovudine and Lamivudine), Trizivir (Zidovudine, Lamivudine and Abacavir), Epzicom (Abacavir and Lamivudine) and Truvada (Tenofovir and Lamivudine). We expect more combination drugs to be available in the future. Side Effects of NRTIs Side effects from taking NRTIs vary, depending on the individual. We recommend that you consult with your doctor regarding any side effects you experience. Common side effects include:

Abacavir (Ziagen, ABC) Side effects may include fever, rash, fatigue, vomiting, diarrhea, abdominal pain, malaise or fatigue, loss of appetite and respiratory symptoms. Dideoxyinosine (Videx, ddI) Side effects may include nausea, vomiting and bloating. More serious side effects include pancreatitis and peripheral neuropathy. Peripheral neuropathy is a common neurological disorder resulting from damage to the peripheral nerves. Symptoms of peripheral neuropathy include a sharp, burning pain sensation in the hands or legs. Lamivudine (Epivir, 3TC) Side effects may include cough, diarrhea, dizziness, headache, loss of appetite, mild stomach cramps or pain and trouble sleeping. More serious side effects include burning, tingling, or pain in the hands, arms, feet, or legs;

chills; ear, nose, or throat problems; fever; muscle aches; nausea; pale skin; severe stomach pain; skin rash; unusual tiredness or weakness; vomiting; and yellow eyes or skin. Stavudine (Zerit, d4T) Side effects may include peripheral neuropathy. Symptoms of peripheral neuropathy include a sharp, burning pain sensation in the hands or legs. In rare cases, Stavudine also may cause pancreatitis. Tenofovir (Viread, TDF) Side effects may include weakness and lack of energy, headache, diarrhea, nausea, vomiting and intestinal gas. More serious side effects include liver or kidney failure and pancreas disease. Zalcitabine (Hivid, ddC) Side effects may include oral ulcers and peripheral neuropathy. Symptoms of peripheral neuropathy include a sharp, burning pain sensation in the hands or legs. Zidovudine (Retrovir, ZDV or AZT) Side effects may include diarrhea, nausea, vomiting, headache, insomnia, weakness and fatigue, bone marrow suppression, anemia and neutropenia. Neutropenia refers to an abnormally low number of neutrophils in the blood. Neutrophils, a type of white blood cell, help fight bacterial infections. Neutropenia isn't a disease but a sign of an underlying problem. In mild cases, it may cause no symptoms. Severe neutropenia increases the risk of infection of the lungs, kidneys, blood and skin.

Protease Inhibitors (PI)

These FDA-approved drugs interrupt virus replication at a later step in the virus life cycle. Protease inhibitors include:

Amprenavir (Agenerase, APV) Atazanavir (Reyataz, ATV) Fosamprenavir (Lexiva, FOS) Indinavir (Crixivan, IDV) Lopinavir (Kaletra, LPV/r) Ritonavir (Norvir, RIT) Saquinavir (Fortovase, Invirase, SQV)

Side Effects of PIs Side effects from protease inhibitors vary, depending on the individual. We recommend that you consult with your doctor to discuss any side effects you may experience. The following is a list protease inhibitors and their possible side effects:

Amprenavir (Agenerase, APV) Side effects include nausea, diarrhea, vomiting, rash, numbness around the mouth and abdominal pain. About 1 percent of people have serious skin reactions, including Stevens-Johnson syndrome. Atazanavir (Reyataz, ATV) Side effects include headache, rash, stomach pain, vomiting, depression, increased cough, trouble sleeping, tiredness, back pain, joint pain, as well as numbness, tingling or burning of the hands or feet. More serious side effects

include yellowing of the eyes or skin, change in heart rhythm, diabetes and high blood sugar, diarrhea, infection, nausea and blood in the urine. Fosamprenavir (Lexiva, FOS) Side effects may include rash, nausea and diarrhea. Indinavir (Crixivan, IDV) Side effects include change in sense of taste, diarrhea, nausea, vomiting, dizziness or drowsiness, general feeling of weakness, headache, stomach pain and trouble sleeping. More serious side effects include kidney stones, changes in body fat, increased bleeding in patients with hemophilia, high sugar and fat levels in the blood, and onset or worsening of diabetes. Lopinavir (Kaletra, LPV/r) Side effects include abdominal pain, abnormal stools or bowl movements, diarrhea, feeling weak or tired, headache and nausea. In addition, patients taking Lopinavir should be monitored for possible liver problems. People taking the drug who have liver disease, such as hepatitis B or hepatitis C, may experience a worsening of their liver condition. A small number of patients have experienced severe liver problems. Nelfinavir (Viracept, NFV) Side effects include diarrhea, weakness, headache, nausea and abdominal pain. Ritonavir (Norvir, RIT) Ritonavir often is used in combination with other protease inhibitors an approach called "Ritonavir boosting." Studies have shown that small amounts of Ritonavir, taken in combination with other PIs, can boost or increase the strength and effectiveness of some drugs and may overcome drug and food interactions. In some cases, "Ritonavir boosting" reduces the number of pills necessary or how often they're taken. The disadvantage is that Ritonavir interacts with many drugs, both prescription and over the counter. It is important that you speak with your doctor about all your medications before taking Ritonavir. Side effects include general weakness, burning or prickling sensation in the hands and feet, stomach pain, diarrhea, constipation, indigestion, flatulence, nausea, vomiting, loss of appetite, change in sense of taste, headache, dizziness, drowsiness, insomnia, fever, throat irritation, abnormal thinking, rash, sore throat and sweating. More serious effects include pancreas disease, changes in body fat, increased bleeding in patients with hemophilia, high sugar and fat levels in the blood, and onset or worsening of diabetes. Saquinavir (Fortovase, Invirase, SQV) Side effects are related to the stomach and intestinal system, including diarrhea, nausea, stomach-intestinal pain, heartburn, rectal gas, vomiting, altered taste sensation, headache, fatigue, depression, sleep disturbance including insomnia, anxiety, sex drive disorder, muscle aches, rash, hepatitis and abnormal fat redistribution.

Other AIDS Medications

Fusion Inhibitors Fusion inhibitors are a new class of drugs that act against HIV by preventing the virus from fusing with the inside of a cell, preventing it from replicating. The group of drugs includes Enfuvirtide, also known as Fuzeon or T-20.

Highly Active Antiretroviral Therapy (HAART) In 1996, highly active antiretroviral therapy (HAART) was introduced for people with HIV and AIDS. HAART often referred to as the anti-HIV "cocktail" is a combination of three or more drugs, such as protease inhibitors and other anti-retroviral medications. The treatment is highly effective in slowing the rate at which the HIV virus replicates itself, which may slow the spread of HIV in the body. The goal of HAART is to reduce the amount of virus in your body, or the viral load, to a level that can no longer be detected with blood tests. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) block the infection of new cells by HIV. These drugs may be prescribed in combination with other anti-retroviral drugs. NNRTs include:

Delvaridine (Rescriptor, DLV) Efravirenz (Sustiva, EFV) Nevirapine (Viramune, NVP)

Reviewed by health care specialists at UCSF Medical Center. Last updated May 20, 2012

AIDS Diagnosis
People are diagnosed with AIDS when they have certain signs or symptoms defined by the U.S. Centers for Disease Control and Prevention (CDC). The CDC's definition of AIDS includes:

Less than 200 CD4+ T cells per cubic millimeter of blood, compared with about 1,000 CD4+ T cells for healthy people. CD4+T cells are white blood cells that play an important role in the body's immune system. These cells are destroyed by HIV. Even when a HIV-positive person feels well and is not experiencing any symptoms of the disease, CD4+ T cells are being infected by HIV. CD4+ T cells accounting for less than 14 percent of all lymphocytes, a type of white blood cell. One of more of the illnesses listed below: o Candidiasis of bronchi, esophagus, trachea or lungs o Cervical cancer that is invasive o Coccidioidomycosis that has spread o Cryptococcosis that is affecting the body outside the lungs o Cryptosporidiosis affecting the intestines and lasting more than a month o Cytomegalovirus disease outside of the liver, spleen or lymph nodes o Cytomegalovirus retinitis that occurs with vision loss o Encephalopathy that is HIV-related o Herpes simplex including ulcers lasting more than a month or bronchitis, pneumonitis or esophagitis o Histoplasmosis that has spread o Isosporiasis affecting the intestines and lasting more than a month o Kaposi's sarcoma o Lymphoma that is Burkitt type, immunoblastic or that is primary and affects the brain or central nervous system o Mycobacterium avium complex or disease caused by M kansasii o Mycobacterium tuberculosis in or outside the lungs o Other species of mycobacterium that has spread o Pneumocystis jiroveci, formerly called carinii, pneumonia o Pneumonia that is recurrent o Progressive multifocal leukoencephalopathy o Salmonella septicemia that is recurrent o Toxoplasmosis of the brain, also called encephalitis o Wasting syndrome caused by HIV infection

Symptoms also may include anxiety, dementia, depression and insomnia.

Tests for HIV and AIDS

Blood tests are the most common way to diagnose the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). These tests look for antibodies to the virus that are present in the blood of infected individuals. People exposed to the virus should get tested immediately.

Early testing is crucial with HIV. If you test positive for the virus, you and your doctor can develop a treatment plan to help fight HIV and ward off complications. Early testing also can alert you to avoid high-risk behavior that could spread the virus to others. Because it can take from six weeks to six months to develop antibodies to the virus, follow-up tests may be needed. Your doctor will ask about your symptoms, medical history and risk factors and perform a physical examination. The primary tests for diagnosing HIV and AIDs include:

ELISA Test ELISA, which stands for enzyme-linked immunosorbent assay, is used to detect HIV infection. If an ELISA test is positive, the Western blot test is usually administered to confirm the diagnosis. If an ELISA test is negative, but you think you may have HIV, you should be tested again in one to three months. ELISA is quite sensitive in chronic HIV infection, but because antibodies aren't produced immediately upon infection, you may test negative during a window of a few weeks to a few months after being infected. Even though your test result may be negative during this window, you may have a high level of the virus and be at risk of transmitting infection. Home Tests The only home test approved by the U.S. Food and Drug Administration is called the Home Access Express Test, which is sold in pharmacies. Saliva Tests A cotton pad is used to obtain saliva from the inside of your cheek. The pad is placed in a vial and submitted to a laboratory for testing. Results are available in three days. Positive results should be confirmed with a blood test. Viral Load Test This test measures the amount of HIV in your blood. Generally, it's used to monitor treatment progress or detect early HIV infection. Three technologies measure HIV viral load in the blood reverse transcription polymerase chain reaction (RT-PCR), branched DNA (bDNA) and nucleic acid sequence-based amplification assay (NASBA). The basic principles of these tests are similar. HIV is detected using DNA sequences that bind specifically to those in the virus. It is important to note that results may vary between tests. Western Blot This is a very sensitive blood test used to confirm a positive ELISA test result.

Reviewed by health care specialists at UCSF Medical Center. Last updated May 20, 2012

Kaposi's Sarcoma
Kaposi's sarcoma (KS) is a disease in which cancer or malignant cells are found in the tissues under the skin or mucous membranes that line the mouth, nose and anus. Until the early 1980s, Kaposi's sarcoma was a very rare disease found mainly in older men, patients who had organ transplants or African men. With the AIDS epidemic in the early 1980s, doctors began to notice more cases of Kaposi's sarcoma in Africa and in gay men with AIDS. Kaposi's sarcoma usually spreads more quickly in these patients. The chance of recovery depends on what type of Kaposi's sarcoma you have, your age and general health, and whether or not you have AIDS. Although KS often responds well to treatment, recurrent disease is common. This means that KS will likely recur after it has been treated. It may come back in the area where it first started or in another part of the body.

Signs and Symptoms Types Treatment

If there are signs of Kaposi's sarcoma (KS), a doctor will examine the skin and lymph nodes carefully. Lymph nodes are small, bean- shaped structures that are found throughout the body. They produce and store infection-fighting cells. The doctor also may recommend other tests to see if the patient has other diseases. KS causes red or purple patches, called lesions, on the skin as well as on mucous membranes. It may spread to other organs in the body, such as the lungs, liver or intestinal tract..

Kaposi's Sarcoma Types

Patients are grouped depending on which type of Kaposi's sarcoma they have. There are three types of Kaposi's sarcoma:

Classic Classic Kaposi's sarcoma is often described as occurring mainly in older men of Jewish, Italian or Mediterranean heritage. However, it also is relatively more common throughout much of sub-Saharan Africa, South America, the Middle East and the former Soviet Union and Eastern Europe than in Western Europe and the United States. This type of Kaposi's sarcoma progresses slowly, sometimes over a period of 10 to 15 years. As the disease gets worse, the lower legs may swell and the blood may not be able to flow properly. After some time, the disease may spread to other organs. Immunosuppressive-Treatment Related Kaposi's sarcoma may occur in people who are taking drugs called immunosuppresants to make their immune systems weaker. The immune system helps the body fight off infection. People who have had organ transplants, such as a liver or kidney transplants, have to take drugs to prevent their immune systems from attacking the new organs. Epidemic Kaposi's sarcoma in patients who have AIDS is called epidemic Kaposi's sarcoma. It usually spreads more quickly than other kinds of Kaposi's sarcoma and often is found in many parts of the body.

kaposi's Sarcoma Treatment

Four kinds of treatment generally are used to treat patients with Kaposi's sarcoma:

Surgery to remove the cancer Chemotherapy, using drugs to kill cancer cells Radiation therapy, using high-dose X-rays to kill cancer cells Biological therapy, using the body's immune system to fight cancer

Surgery
Surgery means removing the cancer. A doctor may remove the cancer using one of the following:

Surgically cutting out the lesion and some of the tissue around it Electrodesiccation and curettage to burn the lesion and remove it with a sharp instrument Cryotherapy to freeze the tumor and kill it

Chemotherapy
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body and can kill cancer cells outside the original site. Because Kaposi's sarcoma is a systemic disease, often developing in several different locations at once, a systemic treatment often is needed. A safe and fairly effective chemotherapy drug commonly used to treat Kaposi's sarcoma is liposomal doxorubicin, known as Doxil. Chemotherapy for Kaposi's sarcoma also may be injected into the lesion, a treatment called intralesional chemotherapy.

Radiation Therapy
Radiation therapy uses high-dose X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation therapy used to be a common treatment of Kaposi's sarcoma but it is a local treatment for a disease that often is widespread. Another limitation is that it can only be used at each location, yet KS tends to recur.

Biological Therapy
Biological therapy tries to get the body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. Interferon can be useful for some patients with KS, especially if their immune systems are relatively healthy. Reviewed by health care specialists at UCSF Medical Center. Last updated May 20, 2012