Session for Primary Care Physicians

ASHM

When to Stop - ARV toxicity. Dr Jonathan Anderson (Australia) discussed long-term ARV toxicity, but first noted the importance of avoiding drug therapy if there are increased risk factors at baseline for side effects, decreasing ARV exposure if possible, detect toxicity before disease becomes apparent to the patient and the use of palliative treatment for side effects. While this is not new Jonathan also reminded the audience to remember the basics: do the history, the physical and then investigations; ask patient if they have toxicity symptoms and involve patient in decision to stop ARV's. Some of the highlights are that one can treat Nelfinivir associated diarrhoea with calcium and use cold food/drinks to address nausea. He also noted that Chinese herbs could help with some elevated liver enzymes. There is no current evidence that monitoring amylase or lactic acid is useful unless the patient is ill or has abdominal pain. He does know that L-carnitine three gm/day for three months has been successful in 80 percent of patients in reducing the pain of peripheral neuropathy.