Question

Which drugs should I take if I go back to Chile?

30 March 2010. Related: Access to treatment, All topics, Side effects, Starting treatment, Travel.

Hi there guys.

First of all thank you for all the good work.

My question might seem to be very specific and personal and hope I can get some guidance from you. I am originally from Chile and am now a citizen of the UK. I tested positive for HIV a year ago. I have recently gone back to my country on a long holiday and I have found myself falling for a local guy, typical story isn’t it? I have been considering going back to settle in Chile but being HIV positive has made my decision somehow more difficult as the level of care I would get over there is less satisfactory than the care I could get in the UK.

My question is regarding treatment. There are treatments available in Chile free of cost but I was wondering if you could give me your views in respect of their side effects and which drugs I should be taking. Here is the list of what is available:

Nucleoside Reverse Transcriptase Inhibitors (NRTIs or nukes)

abacavir (ABC)

didanosine (Ddl)

stavudine (D4T)

lamivudine (3TC)

zidovudine (AZT)

lamivudine + zidovudine (Combivir)

lamivudine + abacavir (Kivexa)

lamivudine + zidovudine + abacavir (Trizivir)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs or non-nukes)

nevirapine (NVP)

efavirenz (EFV)

Protease inhibitors (PIs)

amprenavir/fosamprenavir (APV/FPV)

atazanavir (ATV)

indinavir (IDV)

lopinavir (LPV)

nelfinavir (NFV)

ritonavir (RTV)

saquinavir (SQV)

I would really appreciate if you give me your opinion on this matter and whether based on this limited information should I consider relocating. Again many thanks for such fantastic work.

Answer

Answer: Charlotte Walker

Thank you for your question.

You are very lucky having such a variety of HIV medications available to you free of charge in Chilie. The drugs you have listed above are very similar to what is available in the UK.

It would be useful to know if you are currently on HIV treatment? If so which treatments are you taking at the moment?

To go through the side-effects of all of the drugs you have listed above individually would take a long time. There are some great websites which explain the drug interactions and side effects of each drug in detail. It may be easier for you to read the i-base guides, ‘Introduction to Combination Therapy’ and ‘Avoiding and Managing Side-Effects’. These booklets are free to download or you can order them on line and we can send you a free copy. We can even send you updates when you are in Chilie if you would find it useful?

The drug to avoid, if you have the choice, is stavudine (d4t) because it is known to have toxic side-effects and is now no longer used in the UK. The World Health Organisation (WHO) also recently developed guidelines which stated that stavudine should not be used as a HIV treatment. All other drugs listed above are liscenced in the UK.

The first-line treatment in the UK tends to be 2 NRTIs and 1 NNRTI or 2NNRTIs and 1 PI boosted with ritonavir. However, as I said HIV treatment is very individual and which treatments you should take will depend on your liver and kidney function, any medical conditions you may have, the side-effects you personally experience and other such factors.

Most people experience only mild to moderate side-effects when they first begin medication. There are treatments available for side effects to make them easier to manage.  You should find that after 2-4 weeks your body begins to adjust to the medication and the side effects lessen. If after this time the side effects are still bad you should speak to your doctor.

It may be worth speaking to your doctor in the UK before you leave to get his/her opinion as to the best first-line combination for you, assuming you are not already on HIV treatments.

Good luck with your new life and new relationship!