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The prevalence of type II diabetes in patients with HIV is an uncommon though important concern. The development of type II diabetes in patients on HAART is 2 to 10%, and its prevalence is directly proportional to the time on therapy. As more patients continue to live longer with HIV while on anti-retroviral therapies, more information will become available as to any direct effect these drugs have on the development of diabetes.
Diabetes in HIV patients is of particular concern because of the nature of HIV and the symptoms that can accompany diabetes. Type II diabetes is the form of diabetes that develops in adults as a result of a gradual decline in insulin sensitivity and a decline in insulin production. More serious problems can emerge in cases of severe type II diabetes, such as:
- Lesions in the retina of the eye
- Diabetic nephropathy
- Diabetic neuropathy
- Bacterial or fungal skin infections
- Cardiovascular disease
As a co-morbidity to HIV, it is understandable why preventing or treating diabetes would be paramount to the overall health of the patient.
Additionally, diabetes substantially increases the risk of heart disease, in part because when large amounts of glucose are present in the blood, it attaches to low-density lipoprotein (LDL). This causes the cholesterol to oxidize more easily, and forms a plaque onto blood vessels. When sucrose attaches to high density lipoprotein (HDL), it is less easy for this cholesterol to be removed from the bloodstream by the liver. High glucose levels also increase blood clotting and reduce the elasticity of blood vessels, both contributing factors in the development of cardiovascular problems.
Patients can prevent or treat diabetes with simple lifestyle changes like diet and exercise, or if it progresses, with medication. Dietary changes recommended for people with diabetes include:
- Increasing fiber intake
- Reducing consumption of saturated fats
- Reducing consumption of trans fatty acids
- Increasing consumption of polyunsaturated fats
Exercise is an important part of cardiovascular health, and can play a pivotal role in the prevention or treatment of diabetes. It is highly recommended that patients exercise vigorously so that the heart rate is above normal for at least 20 minutes daily. Common exercises to achieve this can include:
- Brisk walking
- Jogging
- Swimming
- Cycling
- Aerobics class
Consultation with a specialist HIV dietitian is recommended before commencing a diet targeting diabetes, to ensure it will not worsen wasting levels of blood fats, or the absorption of anti-HIV medications.
INDICATION AND IMPORTANT SAFETY INFORMATION
VIRAMUNE is indicated for use in combination with other antiretroviral agents for the treatment of HIV-1 infection. This indication is based on one principal clinical trial that demonstrated prolonged suppression of HIV-RNA and two smaller supportive studies.
Life-threatening and fatal hepatotoxicity has occurred in patients receiving VIRAMUNE. Any patient can experience hepatic events; however, female gender and higher CD4 counts at initiation of therapy place patients at greater risk. Women, including pregnant women, with CD4+ cell counts >250 cells/mm3 are at the greatest risk. VIRAMUNE should not be initiated in adult females with CD4+ cell counts greater than 250 cells/mm3 or in adult males with CD4+ cell counts greater than 400 cells/mm3 unless the benefit outweighs the risk. Hepatic events are often associated with rash. Hepatic failure has also been reported in patients without HIV taking VIRAMUNE for post-exposure prophylaxis (PEP). Use of VIRAMUNE for occupational and non-occupational PEP is contraindicated.
Life-threatening and fatal skin reactions have also occurred, including Stevens-Johnson Syndrome, toxic epidermal necrolysis and hypersensitivity reactions characterized by rash, constitutional findings, and organ dysfunction.
Patients should be intensively monitored for hepatic and skin reactions for the first 18 weeks of therapy with extra vigilance during the first 6 weeks, which is the period of greatest risk. Frequent monitoring should be performed throughout therapy with VIRAMUNE.
VIRAMUNE should be discontinued and not restarted in patients who develop signs or symptoms of hepatitis, hypersensitivity, severe skin reactions or any rash accompanied by constitutional findings. In some cases, hepatic injury has progressed despite discontinuation of treatment.
Patients with either hepatic fibrosis or cirrhosis should be monitored carefully for evidence of drug induced toxicity. VIRAMUNE should not be administered to patients with moderate or severe (Child Pugh Class B or C, respectively) hepatic impairment.
Other common side effects include nausea, fatigue, fever, headache, vomiting, diarrhea, abdominal pain, and myalgia. Immune reconstitution syndrome has been reported in patients treated with combination ARV therapy.
The dose of VIRAMUNE for adults is one 200-mg tablet daily for the first 14 days (this has been shown to reduce the frequency of rash), followed by one 200-mg tablet twice daily. Any patient experiencing rash during the 14-day lead-in period should not increase dose until the rash has resolved. The lead-in dosing regimen should not be continued beyond 28 days.
Please see full Prescribing Information, including boxed WARNING, for VIRAMUNE.
