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An Introduction to Antiretroviral Therapy Drug Drug Adherence Adherence - - A A Key Key

An Introduction to Antiretroviral Therapy

An Introduction to Antiretroviral Therapy Drug Drug Adherence Adherence - - A A Key Key to
An Introduction to Antiretroviral Therapy Drug Drug Adherence Adherence - - A A Key Key to

DrugDrug AdherenceAdherence -- AA KeyKey toto TreatmentTreatment SUCCESS

- - A A Key Key to to Treatment Treatment S U C C E S
- - A A Key Key to to Treatment Treatment S U C C E S

Special Preventive Programme

to to Treatment Treatment S U C C E S S Special Preventive Programme Centre for

Centre for Health Protection

Department of Health

to to Treatment Treatment S U C C E S S Special Preventive Programme Centre for

Content

Content Preface The Human Immunodeficiency Virus (HIV) life cycle What is antiretroviral therapy? Effects of

Preface

Content Preface The Human Immunodeficiency Virus (HIV) life cycle What is antiretroviral therapy? Effects of

The Human Immunodeficiency Virus (HIV) life cycle

Preface The Human Immunodeficiency Virus (HIV) life cycle What is antiretroviral therapy? Effects of antiretroviral

What is antiretroviral therapy?

Effects of antiretroviral therapy
Effects of antiretroviral therapy
is antiretroviral therapy? Effects of antiretroviral therapy What kinds of antiretroviral therapy are available in Hong

What kinds of antiretroviral therapy are available in Hong Kong?

kinds of antiretroviral therapy are available in Hong Kong? When to consider using antiretroviral therapy? Special

When to consider using antiretroviral therapy?

Special attention while taking antiretroviral drugs
Special attention while taking antiretroviral drugs

Nine tips on successful drug taking

antiretroviral drugs Nine tips on successful drug taking How to control over antiretroviral therapy? How to

How to control over antiretroviral therapy?

drug taking How to control over antiretroviral therapy? How to know whether treatment is working? What

How to know whether treatment is working?

therapy? How to know whether treatment is working? What is meant by "undetectable" viral load? The

What is meant by "undetectable" viral load?

working? What is meant by "undetectable" viral load? The importance of drug adherence Degree of drug

The importance of drug adherence

Degree of drug adherence Non-adherence can lead to drug resistance Signs of treatment failure
Degree of drug adherence
Non-adherence can lead to drug resistance
Signs of treatment failure

Side effects of antiretroviral therapy

Managing side effects The use of antiretroviral agents for prophylaxis
Managing side effects
The use of antiretroviral agents for prophylaxis

Conclusion

Appendix
Appendix

I.

I.
I.
I.
I.
I.
I.
I.

Classes of antiretroviral drugs

II .

II .
II .
II .
II .
II .

Progress sheet

 

III.

III.
III.
III.
III.
III.
III.
III.
III.
III.
III.

Useful telephone numbers and websites

PREFACE The use of antiretroviral therapy can effectively control HIV and its disease progress. Successful
PREFACE The use of antiretroviral therapy can effectively control HIV and its disease progress. Successful

PREFACE

The use of antiretroviral therapy can effectively control HIV and its disease progress. Successful treatment depends on how you know about and get the most from your medicine over a long period of time. Stay on your medication and work together with your health care providers is a smart way to reach the goal.

This booklet aims to promote your understanding about how antiretroviral therapy can help you live a longer and healthier life. If you have further questions after reading this booklet, please be sure to talk to your doctor and / or other health care providers to obtain the feedback.

1
1

The Human Immunodeficiency Virus (HIV) life cycle

1 The Human Immunodeficiency Virus (HIV) life cycle HIV enters a healthy CD4 cell. Once inside

HIV enters a healthy CD4 cell. Once inside the cell, HIV coverts its own genetic material RNA into DNA using the enzyme reverse transcriptase. This new DNA acts as a blueprint directing the infected cell to make new virus particles. Mature viral cores are produced through action of viral protease after budding. The new virus is then released and can infect other healthy cells. Thus, the function of immune system will be progressively destroyed.

healthy cells. Thus, the function of immune system will be progressively destroyed. Human DNA HIV DNA
Human DNA HIV DNA HIV DNA HIV RNA
Human DNA
HIV DNA
HIV DNA
HIV RNA
2
2

What is antiretroviral therapy (ART) ?

2 What is antiretroviral therapy (ART) ? The antiretroviral agents attack HIV at different stages of
2 What is antiretroviral therapy (ART) ? The antiretroviral agents attack HIV at different stages of
2 What is antiretroviral therapy (ART) ? The antiretroviral agents attack HIV at different stages of
2 What is antiretroviral therapy (ART) ? The antiretroviral agents attack HIV at different stages of

The antiretroviral agents attack HIV at different stages of its life cycle to inhibit HIV replication and thus bring the viral load down. Combination therapy of two or more drug components has become the standard of treatment of HIV disease.

"Cocktail" is a colloquial term for HIV combination therapy.

Highly active anti-retroviral therapy (HAART) HAART refers to very potent regimen in which almost invariably inhibits viral replication to an undetectable level in the blood. An example of HAART is the use of triple therapy comprises 2 Nucleoside Reverse Transcriptase Inhibitors (NRTI) and 1 Protease Inhibitors (PI).

Reverse Transcriptase Inhibitors (NRTI) and 1 Protease Inhibitors (PI). 5 Drug Adherence - A key to
Reverse Transcriptase Inhibitors (NRTI) and 1 Protease Inhibitors (PI). 5 Drug Adherence - A key to
Reverse Transcriptase Inhibitors (NRTI) and 1 Protease Inhibitors (PI). 5 Drug Adherence - A key to
Reverse Transcriptase Inhibitors (NRTI) and 1 Protease Inhibitors (PI). 5 Drug Adherence - A key to
5
5

Drug Adherence - A key to treatment success

3
3

Effects of antiretroviral therapy

3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level
3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level
3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level
3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level
3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level
3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level
3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level
3 Effects of antiretroviral therapy Goals of Therapy Suppression of viral replication to an undetectable level

Goals of Therapy Suppression of viral replication to an undetectable level is the goal of HAART. Effectiveness of the treatment is readily demonstrable by a precipitous fall in plasma viral load and often a rise in CD4 count.

4
4

What kinds of antiretroviral therapy are available in Hong Kong?

kinds of antiretroviral therapy are available in Hong Kong? (I) (I) (NRTI) 1 1 1 There

(I)

(I)

(NRTI)
(NRTI)

111

There are three classes of antiretroviral drugs available in Hong Kong

(Appendix I):

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI)

Action: HIV's enzyme called reverse transcriptase convert RNA to

DNA. NRTI block reverse transcription by providing faulty

building blocks that interrupt the process.

providing faulty building blocks that interrupt the process. Currently available drugs in this class are: 1.

Currently available drugs in this class are:

1. Zidovudine

(AZT)

(Retrovir)

2. Didanosine

(ddI)

(Videx)

3. Didanosine EC

(ddIEC)

(Videx EC)

4. Lamivudine

(3TC)

(Epivir)

5. Zalcitabine

(ddC)

(Hivid)

6. Stavudine

(d4T)

(Zerit)

7. Combivir

(CBV)

8.

Abacavir

(ABC)

(Ziagen)

9.

Tenofovir

(TDF)

(Viread)

10. Trizivir

(ABC+AZT+3TC)

222

(II)

(NNRTI)
(NNRTI)

(II) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

Action: NNRTI stop HIV production by binding directly onto reverse

transcriptase and prevent the enzyme from converting RNA

to DNA.

and prevent the enzyme from converting RNA to DNA. Currently available drugs in this class are:

Currently available drugs in this class are:

1. Efavirenz

(EFZ)

(Sustiva)

2. Nevirapine

(NVP)

(Viramune)

3

33

(III)

(III)

(PI)

Protease Inhibitors (PI)

(Viramune) 3 3 3 (III) (III) (PI) Protease Inhibitors (PI) Action : PI block the action

Action : PI block the action of an enzyme, called Protease that cuts

HIV protein chains into specific proteins needed to assemble

a new copy of HIV. Therefore, PI prevent the cell from producing new HIV.

HIV. Therefore, PI prevent the cell from producing new HIV. Currently available drugs in this class

Currently available drugs in this class are:

1. Indinavir

(IDV)

(Crixivan)

2. Saquinavir

(SQV)

(Hard gel-Invirase, Soft gel-Fortovase)

3. Ritonavir

(RTV)

(Norvir)

4. Nelfinavir

(NFV)

(Viracept)

5. Kaletra

(LPV+RTV)

8
8
5
5

When to consider using antiretroviral therapy?

5 When to consider using antiretroviral therapy? The doctor will consider using antiretroviral therapy when the
5 When to consider using antiretroviral therapy? The doctor will consider using antiretroviral therapy when the

The doctor will consider using antiretroviral therapy when the infected individual has suffered clinically or immunologically from the virus or has at a heightened risk of disease progression. The following are the indicators for treatment:

Low CD4 countprogression. The following are the indicators for treatment: High viral load level Signs of opportunistic infection

High viral load levelfollowing are the indicators for treatment: Low CD4 count Signs of opportunistic infection Psychologically well

Signs of opportunistic infection Psychologically well prepared to comply with this long-term treatment in order to achieve the goal of therapyfor treatment: Low CD4 count High viral load level ? ? ? ? ? ? ?

? ? ? ? ? ? ? ? ? ?
?
?
?
?
?
? ?
?
?
?
6
6

Special attention while taking antiretroviral drugs

6 Special attention while taking antiretroviral drugs Different drugs would have different precautions, e.g.: Some drugs
6 Special attention while taking antiretroviral drugs Different drugs would have different precautions, e.g.: Some drugs
6 Special attention while taking antiretroviral drugs Different drugs would have different precautions, e.g.: Some drugs

Different drugs would have different precautions, e.g.:

Some drugs work best when they are taken with food while some should be taken on an empty stomach.Different drugs would have different precautions, e.g.: May need to increase water intake. Some kinds of

May need to increase water intake.with food while some should be taken on an empty stomach. Some kinds of food, drugs,

Some kinds of food, drugs, Chinese medicines or alcohol should be avoided to prevent adverse reaction.on an empty stomach. May need to increase water intake. Some drugs need to be stored

Some drugs need to be stored in a refrigerator or special container.or alcohol should be avoided to prevent adverse reaction. Thus, the infected individual should follow the

Thus, the infected individual should follow the instruction of health care providers when taking antiretroviral drugs.should be avoided to prevent adverse reaction. Some drugs need to be stored in a refrigerator

Thus, the infected individual should follow the instruction of health care providers when taking antiretroviral drugs.
7
7

Nine tips on successful drug taking

7 Nine tips on successful drug taking Commit to drug taking strongly Fit the drug regimen

Commit to drug taking strongly

on successful drug taking Commit to drug taking strongly Fit the drug regimen into your daily

Fit the drug regimen into your daily activities

strongly Fit the drug regimen into your daily activities Keep drugs in the places you usually

Keep drugs in the places you usually go

daily activities Keep drugs in the places you usually go Know well your drug regimen in

Know well your drug regimen in terms of the right dosage, frequency and ways of drug taking

terms of the right dosage, frequency and ways of drug taking Bring along a bottle of
terms of the right dosage, frequency and ways of drug taking Bring along a bottle of

Bring along a bottle of water for drug taking

of drug taking Bring along a bottle of water for drug taking Make use of an

Make use of an alarm clock, a pager or chart to remind yourself the time of drug taking

a pager or chart to remind yourself the time of drug taking Use a pill box

Use a pill box to contain one-day medication to remind yourself of the correct dosage

one-day medication to remind yourself of the correct dosage Seek help from health care providers to

Seek help from health care providers to work out a drug schedule that suit you most

Seek support from significant others youyou cancan dodo thisthis !! Drug Adherence - A key
Seek support from significant others
youyou cancan dodo thisthis
!!
Drug Adherence - A key to treatment success
11
8
8

How to control over antiretroviral therapy?

8 How to control over antiretroviral therapy? 9 How to know whether treatment is working? Health
8 How to control over antiretroviral therapy? 9 How to know whether treatment is working? Health
8 How to control over antiretroviral therapy? 9 How to know whether treatment is working? Health
8 How to control over antiretroviral therapy? 9 How to know whether treatment is working? Health
8 How to control over antiretroviral therapy? 9 How to know whether treatment is working? Health
9
9

How to know whether treatment is working?

therapy? 9 How to know whether treatment is working? Health monitoring blood test: CD4 count reflect
therapy? 9 How to know whether treatment is working? Health monitoring blood test: CD4 count reflect

Health monitoring blood test:

CD4 count reflect how strong immune system is Viral load measurement measure level of HIV
CD4 count
reflect how strong immune system is
Viral load measurement
measure level of HIV in blood
In general, treatment is considered to be working
if the viral load is falling or remains low, and the
CD4 count level is rising or remains stable.
12
10
10

What is meant by "undetectable" viral load?

10 What is meant by "undetectable" viral load? Undetectable viral load means that HIV level is

Undetectable viral load means that HIV level is too low to be picked up by the viral load test. HIV are still in the body and can transmit to others through sexual and blood contact. Therefore, it is essential to continue treatment and take precautions against its spread e.g. safer sex.

continue treatment and take precautions against its spread e.g. safer sex. 13 Drug Adherence - A
continue treatment and take precautions against its spread e.g. safer sex. 13 Drug Adherence - A
13
13

Drug Adherence - A key to treatment success

11 The importance of drug adherence The most important element in the success of your
11
11

The importance of drug adherence

11 The importance of drug adherence The most important element in the success of your anti-HIV

The most important element in the success of your anti-HIV treatment is to strictly adhere to the drug regimen. Good drug adherence can prevent treatment failure and the emergence of resistance. Poor drug adherence will lead to the development of drug resistance, limiting the effectiveness of therapy.

Thus, the most important thing you can do to stay healthy is always to take your drugs in the right way and at the right time.

12
12

Degree of drug adherence

right way and at the right time. 12 Degree of drug adherence The nurse counsellor usually

The nurse counsellor usually calculates your degree of drug adherence by:

usually calculates your degree of drug adherence by: No.of doses of ART taken No.of prescribed doses

No.of doses of ART taken

No.of prescribed doses of ART
No.of prescribed
doses of ART

100%

13 Non-adherence can lead to drug resistance
13
Non-adherence can lead to drug resistance
13 Non-adherence can lead to drug resistance Drug resistance means the reduction of a drug's ability
13 Non-adherence can lead to drug resistance Drug resistance means the reduction of a drug's ability

Drug resistance means the reduction of a drug's ability to work against HIV. Resistance is thought to occur when its target mutates, changing its structure so that the drug can no longer bind to work as well as it used to.

Missing doses or taking even short "drug holidays" give the virus change its form and multiply. When you start taking your drugs again, they may not work as well. Thus, non-adherence to drug regimen can lead to drug resistance.

Cross-resistance:

The mechanism by which HIV that has developed resistance to one drug may also be resistant to other similar drugs.

Drug

Drugconcentration

concentration

DRUG RESISTANCE
DRUG RESISTANCE

Taking drugs regularly helps you control the virus:

Taking drugs regularly helps you control the virus: Virus replication is inhibited, mutation is unlikely to
Taking drugs regularly helps you control the virus: Virus replication is inhibited, mutation is unlikely to
Virus replication is inhibited, mutation is unlikely to occur.
Virus replication is
inhibited, mutation is
unlikely to occur.

Level that inhibits viral replication

is unlikely to occur. Level that inhibits viral replication Taking your drugs on time, every time

Taking your drugs on time, every time is essential and has its reward:

drugs on time, every time is essential and has its reward: Lower or undetectable viral load
drugs on time, every time is essential and has its reward: Lower or undetectable viral load

Lower or undetectable viral load result

higher CD4 count, increase/maintain immune function.

result higher CD4 count, increase/maintain immune function. Non-adherence enables the virus to gain control again:

Non-adherence enables the virus to gain control again:

Non-adherence enables the virus to gain control again: Missed dose!! Virus will replicate! Mutations are more
Non-adherence enables the virus to gain control again: Missed dose!! Virus will replicate! Mutations are more

Missed dose!!

enables the virus to gain control again: Missed dose!! Virus will replicate! Mutations are more frequent

Virus will replicate!

Mutations are more frequent during active replication. Some mutated virus are resistant to drugs.
Mutations are more frequent
during active replication.
Some mutated virus are
resistant to drugs.

TREATMENT FAILURE

mutated virus are resistant to drugs. TREATMENT FAILURE The best way to avoid resistance is to

The best way to avoid resistance is to adhere to the regimen- EVERYDAY, EVERY TIME

14
14

Signs of treatment failure

14 Signs of treatment failure Increase viral load Decrease CD4 count Increase risk of disease progression
14 Signs of treatment failure Increase viral load Decrease CD4 count Increase risk of disease progression

Increase viral load14 Signs of treatment failure Decrease CD4 count Increase risk of disease progression Increase hospitalization and

Decrease CD4 count14 Signs of treatment failure Increase viral load Increase risk of disease progression Increase hospitalization and

Increase risk of disease progressionof treatment failure Increase viral load Decrease CD4 count Increase hospitalization and risk of death Missing

Increase hospitalization and risk of deathload Decrease CD4 count Increase risk of disease progression Missing doses or taking the wrong doses

Missing doses or taking the wrong doses can lead to drug resistance. You can quickly become resistant to antiretroviral drugs if you do not take them at the right time, in the right way and in the right dose. If drug failure is evident in terms of clinical, immunological, or virological deterioration, change of antiretroviral regimen is indicated.

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15 18
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1 5 Side effects of antiretroviral therapy Many side effects are temporary. If you encounter

15 Side effects of antiretroviral therapy

Many side effects are temporary. If you encounter unpleasant side effects, do not discontinue the drugs or alter the dosage by yourself. You should discuss your problem with the health care providers to understand the alternatives of the way and time of drug taking, so that a more appropriate drug taking plan could be developed.

Transient side effects:

Nausea/ vomitingdrug taking plan could be developed. Transient side effects: Diarrhoea Allergy Headache Fatigue Fever Central Nervous

Diarrhoeacould be developed. Transient side effects: Nausea/ vomiting Allergy Headache Fatigue Fever Central Nervous System (CNS)

AllergyTransient side effects: Nausea/ vomiting Diarrhoea Headache Fatigue Fever Central Nervous System (CNS) symptoms

HeadacheTransient side effects: Nausea/ vomiting Diarrhoea Allergy Fatigue Fever Central Nervous System (CNS) symptoms (e.g.

Fatigueside effects: Nausea/ vomiting Diarrhoea Allergy Headache Fever Central Nervous System (CNS) symptoms (e.g. dizziness,

Fevereffects: Nausea/ vomiting Diarrhoea Allergy Headache Fatigue Central Nervous System (CNS) symptoms (e.g. dizziness,

Central Nervous System (CNS) symptoms (e.g. dizziness, insomnia, drowsiness, nightmares, inability to concentrate, etc.)Nausea/ vomiting Diarrhoea Allergy Headache Fatigue Fever P otential l ong term side effects: Anaemia (low

P otential l

ong term side effects:

Anaemia (low red blood cell count)to concentrate, etc.) P otential l ong term side effects: Kidney stones Deranged liver function Peripheral

Kidney stonesl ong term side effects: Anaemia (low red blood cell count) Deranged liver function Peripheral neuropathy

Deranged liver functioneffects: Anaemia (low red blood cell count) Kidney stones Peripheral neuropathy Pancreatitis Redistribution of fat

Peripheral neuropathyred blood cell count) Kidney stones Deranged liver function Pancreatitis Redistribution of fat (lipodystrophy) Metabolic

PancreatitisKidney stones Deranged liver function Peripheral neuropathy Redistribution of fat (lipodystrophy) Metabolic problems

Redistribution of fat (lipodystrophy)Deranged liver function Peripheral neuropathy Pancreatitis Metabolic problems (e.g. increase blood fats/ blood sugar)

Metabolic problems (e.g. increase blood fats/ blood sugar)Pancreatitis Redistribution of fat (lipodystrophy) Neutropenia (an abnormal decrease in the number of

Neutropenia (an abnormal decrease in the number of neutrophils in the blood)Metabolic problems (e.g. increase blood fats/ blood sugar) Drug Adherence - A key to treatment success

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16 20
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1 6 Managing side effects Side effects to antiretroviral drugs are common during the first

16 Managing side effects

Side effects to antiretroviral drugs are common during the first few weeks of treatment. However, these symptoms will often pass as your body gets used to the drugs. You should report any unusual symptoms to your doctor/health care providers. If necessary, your doctor will prescribe medications to help you get over the initial period. The following is a quick reference for managing side effects of antiretroviral drugs.

Managing side effects: A quick reference chart

Diarrhoea Self management: Eat white rice, toast, oatmeal, apple sauce, or bananas Avoid spicy foods,
Diarrhoea
Self management:
Eat white rice, toast, oatmeal, apple sauce, or bananas
Avoid spicy foods, fatty foods, and foods that promote gas,
e.g. peanuts, onion
Avoid high fibre food, such as brown rice or whole grain bread
Drink a lot of liquid to replace fluids lost
Consult your doctor:
Check for signs of infections
Prescribe medications for diarrhoea
Upset Stomach (Nausea, Vomiting, Poor Appetite)

Self management:

 

Eat dry foods like crackers, toast, and dry cerealSelf management:   Sip clear liquids like ginger ale or juice mixed with water Eat foods

Sip clear liquids like ginger ale or juice mixed with water  Eat dry foods like crackers, toast, and dry cereal Eat foods that appeal to you

Eat foods that appeal to you even when you are not hungrySip clear liquids like ginger ale or juice mixed with water Eat small and frequent meals

Eat small and frequent mealsEat foods that appeal to you even when you are not hungry Avoid eating very sweet

Avoid eating very sweet , spicy or fatty foodeven when you are not hungry Eat small and frequent meals Avoid lying down directly after

Avoid lying down directly after a mealfrequent meals Avoid eating very sweet , spicy or fatty food Avoid drinking fluids immediately before,

Avoid drinking fluids immediately before, with or after meals, spicy or fatty food Avoid lying down directly after a meal Consult your doctor:  

Consult your doctor:

 

Prescribe medications for upset stomachbefore, with or after meals Consult your doctor:   Prescribe medications to improve your appetite Clarify

Prescribe medications to improve your appetitedoctor:   Prescribe medications for upset stomach Clarify with your doctor about your drug taking pattern

Clarify with your doctor about your drug taking pattern and the suitable timing of meals to avoid gastric upsetConsult your doctor:   Prescribe medications for upset stomach Prescribe medications to improve your appetite

drug taking pattern and the suitable timing of meals to avoid gastric upset Drug Adherence -
drug taking pattern and the suitable timing of meals to avoid gastric upset Drug Adherence -

Drug Adherence - A key to treatment success

21
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22
Feeling Tired (Fatigue) Self management: Take a balance diet and exercise regularly Get adequate rest
Feeling Tired (Fatigue)
Self management:
Take a balance diet and exercise regularly
Get adequate rest
Ask for help with work so as to save energy for important tasks
Consult your doctor:
Check for signs of anaemia
Dizziness, Confusion, and Sleeping Problems
Self management:
Take medications at the best time of day to reduce side effects,
e.g. Efavirenz is best taken at bedtime
Stay in bed if possible
Consult your doctor:
Consider other causes, leading to the side effect e.g. depression
Enquire about the change of drugs or time of drug taking
Prescribe medications for discomfort
Headache
Self management:
Take adequate rest
Do relaxation exercise
Listen to light music
Consult your doctor:
Prescribe medications for headache
Fat Problems (Lipodystrophy)

Self management:

 
Get regular exercise and eat a healthy diet. This may not reduce lipodystrophy, but it

Get regular exercise and eat a healthy diet. This may not reduce lipodystrophy, but it will keep your weight and overall body fat at a healthier level

Consult your doctor:

   
Enquire about experimental treatments to be used for repairing facial fat changes

Enquire about experimental treatments to be used for repairing facial fat changes

about experimental treatments to be used for repairing facial fat changes Drug Adherence - A key
about experimental treatments to be used for repairing facial fat changes Drug Adherence - A key
24
24
Nerve Problems, Tingling Hands and Feet (Neuropathy) Self management: Avoid walking or standing for a
Nerve Problems, Tingling Hands and Feet (Neuropathy)
Self management:
Avoid walking or standing for a long period of time
Soak your feet in cool water
Massage hands and feet
Avoid wearing tight socks or shoes
Consult your doctor:
Enquire the possibility of change of drugs
Refer to see a neurologist
Prescribe medications for neuropathy
Liver Problems
Self management: Quit or reduce alcohol drinking Consult your doctor: Monitor liver enzyme blood tests
Self management:
Quit or reduce alcohol drinking
Consult your doctor:
Monitor liver enzyme blood tests regularly
Enquire about changing of drugs or alternative therapy
Metabolic Problems

Self management:

Exercise on a regular basis if possibleor alternative therapy Metabolic Problems Self management: Quit or reduce smoking Consult your doctor: Monitor

Quit or reduce smokingSelf management: Exercise on a regular basis if possible Consult your doctor: Monitor cholesterol, triglycerides, and

Consult your doctor:

if possible Quit or reduce smoking Consult your doctor: Monitor cholesterol, triglycerides, and glucose tests (the

Monitor cholesterol, triglycerides, and glucose tests (the blood tests that measure fats and sugar in your blood) regularly

tests that measure fats and sugar in your blood) regularly Bone Problems Self management:   Get
tests that measure fats and sugar in your blood) regularly Bone Problems Self management:   Get
Bone Problems
Bone Problems

Self management:

 

Get enough calcium and vitamin D from food, such as fortified soy, rice milkSelf management:   Do weight-bearing exercise like walking or weight lifting Consult your doctor:    

Do weight-bearing exercise like walking or weight liftingand vitamin D from food, such as fortified soy, rice milk Consult your doctor:    

Consult your doctor:

   
Prescribe medications for discomfort

Prescribe medications for discomfort

your doctor:     Prescribe medications for discomfort Drug Adherence - A key to treatment success
your doctor:     Prescribe medications for discomfort Drug Adherence - A key to treatment success
17
17

The use of antiretroviral agents for prophylaxis

17 The use of antiretroviral agents for prophylaxis Effectiveness of antiretroviral drugs is already well-proven as
17 The use of antiretroviral agents for prophylaxis Effectiveness of antiretroviral drugs is already well-proven as

Effectiveness of antiretroviral drugs is already well-proven as prophylaxis to reduce the risk of HIV transmission in two specific health care settings:

Perinatal infection (mother to child transmission)to reduce the risk of HIV transmission in two specific health care settings: Post occupational exposure

Post occupational exposure prophylaxisthe risk of HIV transmission in two specific health care settings: Perinatal infection (mother to child

health care settings: Perinatal infection (mother to child transmission) Post occupational exposure prophylaxis 26
18
18

Conclusion

18 Conclusion By using antiretroviral therapy and adopting good drug adherence practice, you can stay a

By using antiretroviral therapy and adopting good drug adherence practice, you can stay a healthy life. Be relax, take nutritious food, do regular exercise, join a support group and develop a hobby are some smart ways to maintain good health and improve your quality of life.

quality of life

to maintain good health and improve your quality of life. quality of life Drug Adherence -
I (NRTI)
I
(NRTI)

1 Zidovudine

(AZT)

Retrovir

I (NRTI) 1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC
I (NRTI) 1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC
I (NRTI) 1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC
I (NRTI) 1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC
I (NRTI) 1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC

2 Didanosine

(ddI) Videx
(ddI)
Videx
1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine
1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine
1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine

3 Didanosine

EC

(ddIEC)

Videx EC

1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine
1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine
1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine
1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine

4 Lamivudine

(3TC)

Epivir

1 Zidovudine (AZT) Retrovir 2 Didanosine (ddI) Videx 3 Didanosine EC (ddIEC) Videx EC 4 Lamivudine

APPENDIXI Classes of antiretroviral drugs (A)Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI)   Drug Drug

I Classes of antiretroviral drugs I Classes of antiretroviral drugs

(A)Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI)

 
Drug Drug Dosage
Drug
Drug
Dosage

Potential side effects

 
Remarks
Remarks

1

Zidovudine

200mg

Anaemia1 Zidovudine 200mg If nausea, take after

If nausea, take after1 Zidovudine 200mg Anaemia

(AZT)

3

times/day

Neutropenia(AZT) 3 times/day meal

meal

Retrovir

or

G I intoleranceRetrovir or

100mg/cap

300mg

Headache100mg/cap 300mg

2

times/day

Insomnia2 times/day

 

Asthenia 

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoeaHeadache 2 times/day Insomnia   Asthenia 2 Didanosine 125mg or Peripheral neuropathy

2

Didanosine

125mg or

Peripheral neuropathy2 Didanosine 125mg or Chewed/crushed/

Chewed/crushed/

(ddI)

200mg

Pancreatitis(ddI) 200mg dissolved

dissolved

Videx

2

times/day

NauseaVidex 2 times/day Take on empty

Take on emptyVidex 2 times/day Nausea

25mg/tab

 

Diarrhoea25mg/tab   stomach

stomach

100mg/tab

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea100mg/tab Take with IDV at least 1 hr apart

Take with IDV at least 1 hr apart100mg/tab Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

3 Didanosine

250mg or

Peripheral neuropathy3 Didanosine 250mg or Take on empty

Take on empty3 Didanosine 250mg or Peripheral neuropathy

EC

400mg

PancreatitisEC 400mg stomach

stomach

(ddIEC)

daily

Nausea(ddIEC) daily Take with IDV at

Take with IDV at(ddIEC) daily Nausea

Videx EC

DiarrhoeaVidex EC least 1 hr apart

least 1 hr apart

250mg/tab

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea250mg/tab Take with meal if take TDF together

Take with meal if take TDF together250mg/tab Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

400mg/tab

4 Lamivudine

150mg

Minimal toxicity4 Lamivudine 150mg Rapid emergence of

Rapid emergence of4 Lamivudine 150mg Minimal toxicity

(3TC)

2

times/day

Lactic acidosis with hepatic steatosis (rare):(3TC) 2 times/day   resistant strains if non-adherent

 

resistant strains if non-adherent

Epivir

 

150mg/tab

fatigue, severe vomiting, dyspnoea

 
5 Zalcitabine (ddC) Hivid 6 Stavudine (d4T) Zerit 7 Combivir (CBV) Ziagen 8 Abacavir (ABC)

5 Zalcitabine

(ddC) Hivid
(ddC)
Hivid
5 Zalcitabine (ddC) Hivid 6 Stavudine (d4T) Zerit 7 Combivir (CBV) Ziagen 8 Abacavir (ABC) 30
5 Zalcitabine (ddC) Hivid 6 Stavudine (d4T) Zerit 7 Combivir (CBV) Ziagen 8 Abacavir (ABC) 30

6 Stavudine

(d4T) Zerit
(d4T)
Zerit
5 Zalcitabine (ddC) Hivid 6 Stavudine (d4T) Zerit 7 Combivir (CBV) Ziagen 8 Abacavir (ABC) 30

7 Combivir

(CBV)
(CBV)

Ziagen

5 Zalcitabine (ddC) Hivid 6 Stavudine (d4T) Zerit 7 Combivir (CBV) Ziagen 8 Abacavir (ABC) 30
5 Zalcitabine (ddC) Hivid 6 Stavudine (d4T) Zerit 7 Combivir (CBV) Ziagen 8 Abacavir (ABC) 30

8 Abacavir

(ABC)

5 Zalcitabine (ddC) Hivid 6 Stavudine (d4T) Zerit 7 Combivir (CBV) Ziagen 8 Abacavir (ABC) 30
APPENDIX   Drug Dosage   Potential side effects   Remarks 5 Zalcitabine 0.75 mg

APPENDIX

 
Drug Dosage
Drug
Dosage
 

Potential side effects

 
Remarks
Remarks

5

Zalcitabine

0.75 mg

5 Zalcitabine 0.75 mg Peripheral neuropathy    

Peripheral neuropathy

   

(ddC)

3

times/day

(ddC) 3 times/day Stomatitis

Stomatitis

Hivid

 
Hivid   Pancreatitis

Pancreatitis

0.75mg/tab

0.75mg/tab Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

6

Stavudine

30mg or

6 Stavudine 30mg or Peripheral neuropathy    

Peripheral neuropathy

   

(d4T)

40mg

(d4T) 40mg Lipodystrophy

Lipodystrophy

Zerit

2 times/day

Zerit 2 times/day Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

30mg/cap

40mg/cap

Pancreatitis  

Pancreatitis

 
Rapidly progressive ascending neuromuscular weakness (rare)

Rapidly progressive ascending neuromuscular weakness (rare)

7

Combivir

1 tab

7 Combivir 1 tab Anaemia    

Anaemia

   

(CBV)

2 times/day

(CBV) 2 times/day Neutropenia

Neutropenia

=150mg

=150mg Headache

Headache

3TC +

3TC + G I intolerance

G

I intolerance

300mg

300mg Insomnia  

Insomnia

 

AZT/tab

AZT/tab Asthenia

Asthenia

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

8

Abacavir

300mg

 

Hypersensitivity reaction

8 Abacavir 300mg   Hypersensitivity reaction If there is fever, rash, report to health care workers

If there is fever, rash, report to health care workers at once

(ABC)

2

times/day

(5% of people) symptoms may include fever, rash, nausea, vomiting, malaise,

Ziagen

 

300mg/tab

 

fatigue or loss of appetite, respiratory symptoms such

as

sore throat, cough,

shortness of breath

 
9 Tenofovir (TDF) Viread 10 Trizivir (ABC + AZT + 3TC) (NNRTI)
9
Tenofovir
(TDF)
Viread
10
Trizivir
(ABC +
AZT + 3TC)
(NNRTI)

1

Efavirenz

Efavirenz
Efavirenz
Efavirenz

(EFZ)

Stocrin,

Sustiva

 
 
 
APPENDIX   Drug Drug Dosage   Potential side effects   Remarks 9 Tenofovir 300mg

APPENDIX

 
Drug Drug Dosage
Drug
Drug
Dosage
 

Potential side effects

 
Remarks
Remarks

9

Tenofovir

300mg daily

9 Tenofovir 300mg daily Asthenia   Take with meal

Asthenia

 

Take with meal9 Tenofovir 300mg daily Asthenia  

(TDF)

(TDF) Headache Dosage adjustment

Headache

Dosage adjustment(TDF) Headache

Viread

Viread G I intolerance in renal insufficiency

G

I intolerance

in renal insufficiency

300mg/tab

300mg/tab Flatulence  

Flatulence

 
Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

Lactic acidosis with hepatic steatosis (rare): fatigue, severe vomiting, dyspnoea

Rare report of renal  

Rare report of renal

 

insufficiency

10

Trizivir (ABC + AZT + 3TC)

1 tab

10 Trizivir (ABC + AZT + 3TC) 1 tab Anaemia   If there is any flu

Anaemia

 

If there is any flu like10 Trizivir (ABC + AZT + 3TC) 1 tab Anaemia  

2 times/day

2 times/day Neutropenia symptom fever, rash,

Neutropenia

symptom fever, rash,

G I intolerance report to health care

G

I intolerance

report to health care

 
  Headache   workers at once

Headache

 

workers at once

Insomnia

Insomnia

Asthenia

Asthenia

Lactic acidosis with hepatic steatosis: fatigue, severe

Lactic acidosis with hepatic steatosis: fatigue, severe

vomiting, dyspnoea Hypersensitivity reaction

(B)Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

 
Drug Dosage
Drug
Dosage
 

Potential side effects

 
Remarks
Remarks

1

Efavirenz

600mg daily (preferably at bed time)

1 Efavirenz 600mg daily (preferably at bed time) Rash Decrease CNS

Rash

Decrease CNS1 Efavirenz 600mg daily (preferably at bed time) Rash

(EFZ)

(EFZ) CNS symptoms: symptoms if take at bed time

CNS symptoms:

symptoms if take at bed time

Stocrin,

dizziness, somnolence, insomnia, drowsiness, nightmares, hallucinations, poor concentration (usually subside in 2-4 weeks if really appear)

Sustiva

 

Pregnancy is contraindicatedSustiva  

200mg/cap

600mg/tab

 
Increased transaminase levels

Increased transaminase levels

(NVP) Viramune 2 Nevirapine (PI) 1 Indinavir (IDV) Crixivan ( ) Fortovase ( ) 2

(NVP)

(NVP)
(NVP)
(NVP)

Viramune

(NVP) Viramune

2 Nevirapine

(NVP) Viramune 2 Nevirapine (PI) 1 Indinavir (IDV) Crixivan ( ) Fortovase ( ) 2 Saquinavir

(PI)

(NVP) Viramune 2 Nevirapine (PI) 1 Indinavir (IDV) Crixivan ( ) Fortovase ( ) 2 Saquinavir

1 Indinavir

(NVP) Viramune 2 Nevirapine (PI) 1 Indinavir (IDV) Crixivan ( ) Fortovase ( ) 2 Saquinavir

(IDV)

Crixivan

(NVP) Viramune 2 Nevirapine (PI) 1 Indinavir (IDV) Crixivan ( ) Fortovase ( ) 2 Saquinavir
( )
(
)

Fortovase

( )
(
)
(NVP) Viramune 2 Nevirapine (PI) 1 Indinavir (IDV) Crixivan ( ) Fortovase ( ) 2 Saquinavir

2 Saquinavir

(SQV)

Invirase

(NVP) Viramune 2 Nevirapine (PI) 1 Indinavir (IDV) Crixivan ( ) Fortovase ( ) 2 Saquinavir
APPENDIX   Drug Drug Dosage   Potential side effects Remarks 2 Nevirapine 200mg daily

APPENDIX

 
Drug Drug Dosage
Drug
Drug
Dosage
 

Potential side effects

Remarks
Remarks

2

Nevirapine

200mg daily

2 Nevirapine 200mg daily Rash Anti-TB drugs and

Rash

Anti-TB drugs and2 Nevirapine 200mg daily Rash

(NVP)

for 2 weeks, then 200mg

(NVP) for 2 weeks, then 200mg Symptomatic hepatitis oral contraceptive pills should be used with caution

Symptomatic hepatitis

oral contraceptive pills should be used with caution

Viramune

 

200mg/tab

2

times/day

 

Rapid emergence of resistant strains if non-adherent 

(C)Protease Inhibitors (PI)

 
Drug Dosage
Drug
Dosage
 

Potential side effects

 
Remarks
Remarks

1

Indinavir

800mg Q8h

1 Indinavir 800mg Q8h Nephrolithiasis   Take with empty

Nephrolithiasis

 

Take with empty1 Indinavir 800mg Q8h Nephrolithiasis  

(IDV)

3

times/day

(IDV) 3 times/day G I intolerance stomach

G

I intolerance

stomach

Crixivan

 
Crixivan   Increased indirect bilirubinemia 1.5 Drink water

Increased indirect bilirubinemia

1.5 Drink water

1.5Drink water

Drink water

200mg/cap

200mg/cap Misc.: headache, asthenia, blurred vision, dizziness, rash, metallic taste, thrombocytopenia, alopecia, and
Misc.: headache, asthenia, blurred vision, dizziness, rash, metallic taste, thrombocytopenia, alopecia, and hemolytic

Misc.: headache, asthenia, blurred vision, dizziness, rash, metallic taste, thrombocytopenia, alopecia, and hemolytic anaemia

Fat redistribution

litre/day

400mg/cap

Avoid grapefruit juice400mg/cap

Lipid abnormalities  

Lipid abnormalities

 
Hyperglycemia

Hyperglycemia

2

Saquinavir

Invirase

2 Saquinavir Invirase Headache   Take after meal,

Headache

 

Take after meal,2 Saquinavir Invirase Headache  

(SQV)

600mg

(SQV) 600mg G I intolerance preferably fatty to

G

I intolerance

preferably fatty to

Invirase

3

times/day

Invirase 3 times/day Elevated transaminase   increase absorption

Elevated transaminase

 

increase absorption

(hard gel)

Fortovase

enzymes

Rifampicin &(hard gel) Fortovase enzymes

200mg/cap

1200mg

200mg/cap 1200mg Hyperglycemia Rifabutin are

Hyperglycemia

Rifabutin are

Fortovase

3

times/day

Fortovase 3 times/day Fat redistribution contraindicated with

Fat redistribution

contraindicated with

(soft gel)

 
(soft gel)   Lipid abnormalities SQV

Lipid abnormalities

SQV

200mg/cap

200mg/cap Possible increased bleeding episodes in patients with Fortovase (soft gel)

Possible increased bleeding episodes in patients with

Fortovase (soft gel)200mg/cap Possible increased bleeding episodes in patients with

should be refrigerated

hemophilia

 

or stored at room

 

temperature

temperature 25 C

25 C

(up to 3 months)

3 Ritonavir (RTV) Norvir 4 Nelfinavir (NFV) Viracept 5 Kaletra = Lopinavir (LPV) 133.3mg +
3 Ritonavir
(RTV)
Norvir
4 Nelfinavir
(NFV)
Viracept
5 Kaletra
= Lopinavir
(LPV)
133.3mg +
Ritonavir
(RTV)

Reference:

Department of Health, Guidelines for the Use of Antiretroviral Agents in HIV-I-Infected Adults and Adolescents. convened by DHHS. March, 2004. P.59-64

APPENDIX   Drug Dosage   Potential side effects   Remarks 3 Ritonavir 600mg

APPENDIX

 
Drug Dosage
Drug
Dosage
 

Potential side effects

 
Remarks
Remarks

3

Ritonavir

600mg

3 Ritonavir 600mg Headache   Capsules should be

Headache

 

Capsules should be3 Ritonavir 600mg Headache  

(RTV)

2

times/day

(RTV) 2 times/day G I intolerance refrigerated. If stored

G

I intolerance

refrigerated. If stored

Norvir

 
Norvir   Paresthesias - circumoral and at room temperature

Paresthesias - circumoral and

at room temperature

100mg/cap

extremities

 
for
for

25 C, it is stable

syrup

syrup Hepatitis 30 days

Hepatitis

30 days

80mg/ml

80mg/ml Pancreatitis Take after meal to

Pancreatitis

Take after meal to80mg/ml Pancreatitis

Asthenia improve tolerance

Asthenia

improve tolerance

Taste perversion Need dosage

Taste perversion

Need dosageTaste perversion

Lab.: Triglycerides increase adjustment if take with SQV Avoid self-prescribe drugs because of

Lab.: Triglycerides increase

adjustment if take with SQV

Avoid self-prescribe drugs because ofadjustment if take with SQV

> 200%, transaminase elevation, elevated CPK and uric acid

Hyperglycemia   drug interaction

Hyperglycemia

 

drug interaction

Fat redistribution

Fat redistribution

Lipid abnormalities

Lipid abnormalities

Possible increased bleeding episodes in patients with

Possible increased bleeding episodes in patients with

hemophilia

 

4

Nelfinavir

750mg

4 Nelfinavir 750mg Diarrhoea   Take with meal

Diarrhoea

 

Take with meal4 Nelfinavir 750mg Diarrhoea  

(NFV)

3

times/day

(NFV) 3 times/day Hyperglycemia

Hyperglycemia

Viracept

or

Viracept or Fat redistribution

Fat redistribution

250mg/tab

1250mg

250mg/tab 1250mg Lipid abnormalities

Lipid abnormalities

2

times/day

2 times/day Serum transaminase elevation

Serum transaminase elevation

 
  Possible increased bleeding episodes in patients with

Possible increased bleeding episodes in patients with

hemophilia

 

5

Kaletra

3

capsules

5 Kaletra 3 capsules Diarrhoea   Take with meal

Diarrhoea

 

Take with meal5 Kaletra 3 capsules Diarrhoea  

= Lopinavir

2

times/day

= Lopinavir 2 times/day G I intolerance Use additional type of

G

I intolerance

Use additional type of= Lopinavir 2 times/day G I intolerance

(LPV)

 
(LPV)   Asthenia   contraception since

Asthenia

 

contraception since

133.3mg +

133.3mg + Elevated serum transaminases Kaletra may reduce

Elevated serum transaminases

Kaletra may reduce

Ritonavir

Ritonavir Hyperglycemia   the effectiveness of

Hyperglycemia

 

the effectiveness of

(RTV)

(RTV) Fat redistribution oral contraceptives

Fat redistribution

oral contraceptives

33.3mg/cap

33.3mg/cap Lipid abnormalities Should be refrigerated.

Lipid abnormalities

Should be refrigerated.33.3mg/cap Lipid abnormalities

Possible increased bleeding episodes in patients with If stored at room

Possible increased bleeding episodes in patients with

If stored at room

temperature

25 C, it

25 C, it

hemophilia

 

is stable for 2 months

II
II
II 38
II 38

APPENDIXI I Progress Sheet Date CD4 Count Viral Load Remarks Drug Adherence - A key

APPENDIX I I Progress Sheet Date CD4 Count Viral Load Remarks Drug Adherence - A key
APPENDIX I I Progress Sheet Date CD4 Count Viral Load Remarks Drug Adherence - A key

II Progress Sheet

Date CD4 Count Viral Load Remarks
Date
CD4 Count
Viral Load
Remarks
III
III
III 40
III 40
III 40
III 40
III 40
III 40
III 40
III 40
40
40

APPENDIXI I I Useful telephone numbers and websites: Government Organizations: Kowloon Bay Integrated Treatment Centre

I I I Useful telephone numbers and websites: III Useful telephone numbers and websites:

Government Organizations:

Kowloon Bay Integrated Treatment Centretelephone numbers and websites: Government Organizations: Tel: 2117 0333 Red Ribbon Centre Tel: 2304 6268 AIDS

Tel: 2117 0333

Red Ribbon CentreKowloon Bay Integrated Treatment Centre Tel: 2117 0333 Tel: 2304 6268 AIDS Hotline http://www.rrc-hk.com Tel: 2780

Tel: 2304 6268

AIDS HotlineCentre Tel: 2117 0333 Red Ribbon Centre Tel: 2304 6268 http://www.rrc-hk.com Tel: 2780 2211 http://www.27802211.com

http://www.rrc-hk.com

Tel: 2780 2211

http://www.27802211.com

Harm Reduction Hotlinehttp://www.rrc-hk.com Tel: 2780 2211 http://www.27802211.com Tel: 2112 9977 http://www.harmreduction-hk.com AIDS

Tel: 2112 9977

http://www.harmreduction-hk.com

Hotline Tel: 2112 9977 http://www.harmreduction-hk.com AIDS Non-governmental Organizations & Drug related

AIDS Non-governmental Organizations & Drug related Organizations:

Hong Kong AIDS FoundationOrganizations & Drug related Organizations: Tel: 2560 8528 Hotline: 2513 0513

Tel: 2560 8528

Hotline: 2513 0513

http://www.aids.org.hk

AIDS Concern Hotline2560 8528 Hotline: 2513 0513 http://www.aids.org.hk Tel: 2898 4422 http://www.aidsconcern.org.hk The Society for

Tel: 2898 4422

http://www.aidsconcern.org.hk

The Society for AIDS CareConcern Hotline Tel: 2898 4422 http://www.aidsconcern.org.hk Tel 2559 2006 : Teen AIDS

Tel 2559 2006

:

Teen AIDSThe Society for AIDS Care Tel 2559 2006 : http://www.aidscare.com.hk/cindex.htm Tel: 2554 3399

http://www.aidscare.com.hk/cindex.htm

Tel: 2554 3399

http://www.teenaids.org.hk

The Society for the AIDS and Rehabilitation of Drug Abusers (SARDA) HotlineTel: 2554 3399 http://www.teenaids.org.hk Tel: 2574 3300 Overseas Internet / Website for more

Tel: 2574 3300

Overseas Internet / Website for more information about HIV Treatment:

http://www.aidsmap.comInternet / Website for more information about HIV Treatment: http://www.hivatis.org http://www.hivresources.com

http://www.hivatis.orgmore information about HIV Treatment: http://www.aidsmap.com http://www.hivresources.com http://www.iasusa.org

http://www.hivresources.com

http://www.iasusa.orghttp://www.hivatis.org http://www.hivresources.com http://www.medscape.com http://www.treathiv.com

http://www.medscape.com

http://www.treathiv.comhttp://www.iasusa.org http://www.medscape.com http://www.unaids.org Drug Adherence - A key to treatment

http://www.unaids.orghttp://www.iasusa.org http://www.medscape.com http://www.treathiv.com Drug Adherence - A key to treatment success 41

11 / 2004 Production of Integrated Treatment Centre BOK/AA5/04-10(B)HIV-EDU

11 / 2004

Production of Integrated Treatment Centre

BOK/AA5/04-10(B)HIV-EDU