Side-effects: etravirine (Intelence)
Like all medicines, anti-HIV drugs can cause side-effects.
Now, the US Food and Drug Administration (the FDA, the agency that licenses drugs in America) has issued a warning about the risk of a severe rash in people taking etravirine (Intelence).
Etravirine is a new non-nucleoside reverse transcriptase inhibitor (NNRTI), recently approved for treatment-experienced patients in Europe and the US.
A small number of people in a clinical trial of the drug (2% of those taking part) developed a serious rash and had to stop taking the drug. In most cases, this happened within six weeks of starting treatment with etravirine. In the most serious cases, people developed severe skin reactions.
People starting treatment with etravirine should contact their doctor if they develop a rash. Patients are advised to watch out for symptoms accompanying a rash such as fever; generally feeling ill; extreme tiredness; muscle or joint aches; blisters; oral lesions; eye inflammation; facial swelling; signs of liver problems, such as yellowing of the skin or whites of eyes, dark or tea-coloured urine or pale-coloured stools; nausea or vomiting; loss of appetite; pain; aching or sensitivity on the right side below the ribs.
If any of these symptoms occur, you should contact your HIV doctor for monitoring and to change to a different treatment.
The new warning will be included on the patient-information insert in packets of the drug in the US, and it’s expected that the same warning will be added in Europe in the next few weeks.
You can get more information on dealing with side-effects in NAM’s new Side-effects booklet, which is available free to people living with HIV in the UK and is also distributed free through clinics and support groups in the UK. It can also be downloaded as a pdf.HIV, employment and discrimination
With successful HIV treatment, many people with HIV are now either remaining in the workplace or thinking about returning to work or study.
However, stigma and discrimination cause more problems at work than ill-health. And only a small number of people with HIV knew about the protection the Disability Discrimination Act (DDA) gives them.
If people said that HIV was having an impact on their working life, it was most commonly because of feeling very tired (20%), feeling stressed or anxious (13%) or side-effects from treatment (11%). When people were first diagnosed was often a time when having HIV did affect people’s working lives, although not for everyone.
Two-thirds of the respondents to the survey had disclosed their HIV status to someone at work. And when people had disclosed their HIV status at work, most had a positive reaction, but some had experienced discrimination in their current or previous job.
Even people aware of the DDA were not always aware that it gives people with HIV a legal right to recourse because of HIV-related discrimination. Nor did they know about a key feature, which is the right to ask for ‘reasonable adjustments’ in their employment, such as time off for clinic appointments or changes to working hours. Where people had asked for these adjustments, most employers had agreed, fully or partially, to the adjustments.
On the basis of the research results, the NAT has made some recommendations to employers and others to ensure people with HIV can enjoy and contribute to their workplace as much as possible.
HIV and brain impairment
Forms of cognitive impairment are common in people with HIV, ranging from asymptomatic mild impairment to HIV-associated dementia.
A study now suggests that HIV-positive people with good CD4 cell counts (over 350) do not have an increased risk of developing brain impairment. The only characteristic associated with an increased risk is older age.
Although serious impairment has become rare in people on successful HIV treatment, a small number do develop it. People with HIV who do develop cognitive impairment can have poorer outcomes than HIV-negative people, so it’s important the condition is diagnosed as soon as possible, especially in those not yet on treatment where HIV replication may be causing damage.
In the UK, people are recommended to start HIV treatment when their CD4 cell count is around 350.
The May edition of HIV Treatment Update included a feature article on HIV and brain impairment. This edition is now available to download from aidsmap.com.
HIV and kidney function
HIV and meningitis
A minority of people who have both HIV and another condition find that the second condition temporarily worsens after they have started HIV treatment. This is called immune reconstitution inflammatory syndrome (IRIS) and is caused by the improvement in their immune system, which then attacks the co-existing condition.
Researchers in an international study have found that a large proportion of HIV-positive people who also have cryptococcal meningitis develop IRIS after they start HIV treatment. However, there is clear evidence that the benefits of starting antiretroviral therapy far outweigh any risks from developing IRIS.