But AZT gives some people anaemia and many others are resistant to it - in which case abacavir or tenofovir, perhaps plus 3TC or its forthcoming and stronger
equivalent FTC, again become the best options.
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Once-a-day formulations can also improve side effects. For instance, it's been found that the once-daily formulation of d4T - soon to hit the clinics - causes less peripheral neuropathy, and if it does this, it may well cause less lipoatrophy too. Watch this space for more news.
It's unfortunate that the HIV drug that always seems to crop up in the most potent regimes - efavirenz - is also the one that has incontrovertible psychological effects ranging from dizziness to bad dreams and suicidal thoughts.
For many, these effects occur only with the first few doses and are mild. But one study found that 40 per cent of efavirenz users were still experiencing marked anxiety symptoms more than a year after starting the drug. One person said "I thought I was normal on efavirenz - till I stopped!" This is a quality of life issue - which is where we came in.
To improve adherence...
This will be the subject of another piece in a few issues' time. There
are a lot of once-a-day options available or coming along, and we will
be reviewing the possibility of 'regime simplification' soon.
More info
This piece can only scratch the surface. For more info, see the i-Base
Guide to Avoiding and Managing side Effects - issued with September 2001's
Positive Nation (issue 70). Updated issue August 2002 available from i-Base.
(In French and Chinese translations too.)
Also useful is the summary on www.aidsmap.com
under 'Treating body fat and metabolic changes: switching drugs' (search
for the title on Aidsmap's opening page)
i-Base: 020 7407 8488 or admin@i-Base.org.uk
NAM Publications/Aidsmap.com: 020 7627 3200 or info@nam.org.uk
Thanks to Simon Collins and Keith Alcorn
