Living With HIV: Staying Healthy and Avoiding Complications
HIV Complications With Protease and Integrase Inhibitors
Low-dose ritonavir, a protease inhibitor, is now the norm in all protease-based regimens. The higher the amount of ritonavir, though, the greater the chance of gastric side effects and metabolic complications such as central obesity, insulin resistance, and lipid problems, Taiwo says. Paired with the PIs atazanavir or darunavir, the low-dose ritonavir boosts the drug levels of the primary PIs.
Raltegravir is currently the only FDA-approved integrase inhibitor, but several others are in development. "These novel drugs seem to be very well tolerated," Taifo says.
HIV Complications With Fusion Inhibitors
If you become resistant to other medications, your doctor may prescribe a fusion inhibitor called enfuvirtide. With this medication, it is common to have a reaction at the injection site. This may cause pain and other symptoms. However, complications are not common. A rare hypersensitivity reaction causes symptoms that may include a rash, fever, and nausea, for example. And with this medication, you also have an increased risk of bacterial pneumonia.
Avoiding HIV Complications: When Should You Start HIV Treatment?
Decreasing the risk of HIV complications and staying healthy with HIV depends partly on starting treatment in a timely way. But what is considered “timely” has changed over time. Treatment was once started when a person’s CD4 count was under 200. Then it changed to under 350.
Now the recommendation is to start treatment if the CD4 count is less than 500. That may be due in part because the lower the CD4 count goes, the more difficult it is to rebuild the immune system. In fact, many large studies have shown that delaying treatment greatly increases the risk of death over the long term, Taifo says.
For some people, treatment is recommended no matter the CD4 count. This includes pregnant women and people who:
- Have signs of kidney disease, hepatitis B or C co-infection, or many risk factors for heart disease
- Have a viral load more than 100,000 or a CD4 count that's dropping very fast
- Have any signs of AIDS
- Are in relationships with partners who are HIV-negative
- Are 60 or older