Drink at least 48 ounces (six 8-oz. glasses) of water daily to prevent kidney stones.

* Also sold as Aluvia in some parts of the world.

* Also sold as Telzir in some parts of the world.

* Sustiva is a non-nucleoside reverse transcriptase inhibitor (NNRTI)

See additional notes in the descriptions of Emtriva, Viread, and Sustiva below.

* Also sold as Kivexa in some parts of the world.

* Also sold generically in the United States.

* Viread and Emtriva are nucleoside reverse transcriptase inhibitors (NNRTIs)

See additional notes in the descriptions of Sustiva (below), Emtriva, and Viread (above).

* Also sold as Stocrin in some parts of the world.

* Also sold as Celsentri outside the U.S.

• Isentress is an integrase inhibitor manufactured by Merck & Company. It was approved by the U.S. Food and Drug Administration (FDA) in October 2007. Isentress is approved for treatment-experienced patients who have HIV strains that are resistant to multiple antiretroviral drugs. It is not yet approved for people with drug-sensitive HIV strains, such as those starting antiretroviral therapy for the first time.
   
• After HIV’s genetic material is deposited inside a cell, its RNA must be converted (reverse transcribed) into DNA. A viral enzyme called integrase then helps to hide HIV’s DNA inside the cell’s DNA. Once this happens, the cell can begin producing genetic material for new viruses. Integrase inhibitors, such as Isentress, are designed to block the activity of the integrase enzyme and to prevent HIV DNA from meshing with healthy cell DNA.
   
• Isentress must be used in combination with other anti-HIV drugs.
   

What is already known about Isentress?

• The Isentress dose is one 400mg tablet taken by mouth twice a day. It can be taken with or without food.
   
• Isentress holds promise for HIV-positive patients who no longer respond to other HIV drugs. Because Isentress targets HIV differently than all other available antiretrovirals, chances are that many people living with the virus—regardless of which drugs have failed them in the past—will likely benefit from using Isentress. Two large large Phase III clinical trials have determined that Isentress, when combined with other drugs, is effective for patients whose virus has adapted to other HIV drugs used in the past. However, Isentress worked best when it was combined with at least two other drugs that the virus was sensitive to. For this reason, it is best to use drug-resistance testing to determine which drugs your virus is sensitive to; the results will show which antiretrovirals are best to combine with Isentress.
   
• Isentress is not yet approved for people with HIV that have no, or limited, resistance to other available antiretroviral drugs. This includes HIV-positive people beginning treatment for the first time. However, preliminary data from a study evaluating the drug in patients new to HIV treatment suggest that Isentress is comparable to standard-of-care Sustiva (efavirenz), at least for 24 weeks of treatment. The FDA has not yet reviewed these data.
    
• Isentress is not approved for use in HIV-positive children. To learn more about treatment options for children, click here.
   

What about drug interactions?

• Isentress is broken down (metabolized) by the body differently than most medications used to treat HIV and AIDS. This means that Isentress likely has fewer drug interactions when combined with protease inhibitors, non-nucleoside reverse transcriptase inhibitors, methadone, opioid pain relievers, statins, antifungals, proton pump inhibitors, oral contraceptives, and erectile dysfunction drugs.
   
• At the time of Isentress’ approval in October 2007, there were no known “contraindications,” meaning that there are no known medications that must be avoided while taking Isentress.
   
• Isentress can interact with Rifadin (rifampin), a medication used to treat TB, MAC, and other bacterial infections. Rifadin (rifampin) can decrease Isentress levels in the bloodstream. While Isentress dosing adjustments haven’t been recommended, caution is recommended if both drugs are used together.
   
• Isentress can interact with a few HIV medications. Aptivus (tipranavir), combined with Norvir (ritonavir), can decrease levels of Isentress in the bloodstream. However, in a clinical trial involving patients who took both drugs, treatment efficacy was not compromised. Reyataz (atazanavir), combined with Norvir, can increase Isentress levels in the bloodstream. In clinical trials, this was not associated with an increased risk of Isentress side effects. Based on these findings, Isentress dose adjustments are not recommended if it is combined with either Aptivus/Norvir or Reyataz/Norvir.
   
• Interactions between Isentress and other medications may be discovered. Tell your doctors and pharmacists about all medicines you take. This includes those you buy over-the-counter and herbal or natural remedies. Bring all your medicines when you see a doctor, or make a list of their names, how much you take, and how often you take them. Your doctor can then tell you if you need to change the dosages of any of your medications.
   

What is known about side effects?

• The side effects most commonly reported among study volunteers who received Isentress were diarrhea, nausea, and headache.
   
• Blood tests showed abnormally elevated levels of a muscle enzyme—creatine kinase—in some patients receiving Isentress. According to the FDA, Isentress should be used with caution by patients who are at an increased risk of muscle problems like myopathy and rhabdomyolysis, which includes patients using other medications known to cause these conditions.
   

Can pregnant women take Isentress?

• Isentress is classified by the FDA as a pregnancy category C drug. Pregnancy category C means that animal studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. HIV-positive women who become pregnant should discuss the benefits and possible side effects of anti-HIV treatment to help protect their babies from HIV (see our lesson called Family Planning, Pregnancy & HIV).
   
• It is not known whether Isentress passes into breast milk and what effect it may have on a nursing baby. To prevent transmission of the virus to uninfected babies, it is recommended that HIV-positive mothers not breast-feed.
   

Where can I learn more about clinical trials of Isentress?

• If you would like to find out if you are eligible for any clinical trials that include Isentress, there is an interactive web site run by ACRIA, the AIDS Community Research Initiative of America.
   
• Another useful service for finding clinical trials is AIDSinfo.nih.gov, a site run by the U.S. National Institutes of Health. NIH has “health information specialists” you can talk to at their toll-free number at 800.HIV.0440 (800.448.0440).

• Vicriviroc is an experimental entry inhibitor developed by the Schering-Plough Research Institute. Vicriviroc is also sometimes called SCH-D, its former code name.
   
• Vicriviroc binds to a protein on the membrane of T-cells called CCR5. Once it does this, HIV cannot successfully bind with the surface of T-cells, thus preventing the virus from infecting healthy cells.
   
• Vicriviroc is believed to be more powerful than SCH-C, Schering-Plough’s first entry inhibitor that is no longer in development.
   
• Vicriviroc will most likely need to be used in combination with other anti-HIV drugs.

What is already known about vicriviroc?

• A dose for vicriviroc has not yet been determined, though ongoing studies are investigating a dose of 30mg once daily. Vicriviroc is being studied in a pill form, which means that it can be taken by mouth. Vicriviroc will only need to be taken once a day.
   
• Vicriviroc holds promise for HIV-positive patients who have tried and failed other anti-HIV drugs in the past. Because vicriviroc targets HIV differently than the protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs), chances are that most people living with the virus—regardless of their treatment history—will likely benefit from using vicriviroc.
   
• Vicriviroc will likely be active against HIV that is resistant to other entry inhibitors, including Fuzeon (enfuvirtide).
   
•  Vicriviroc might interact with other medications, including those used to treat HIV. It is important that your personal physician and/or the research nurse or study investigator be aware of all drugs you are taking, including those you buy without a prescription.

What about drug interactions?

• Studies have already indicated that the PI Norvir (ritonavir) can increase vicriviroc levels in the bloodstream by 500% (Kaletra can have the same effect). The NNRTI Sustiva (efavirenz) can decrease vicriviroc levels by 80%, although this can be corrected by adding Norvir. Another study found no significant interactions with five of the most commonly used protease inhibitors, all of them boosted with low-dose Norvir.
   
• Studies to determine potential drug interactions are currently planned or ongoing.

What is known about side effects?

• The side effects of vicriviroc have not yet been determined. Other than pulmonary tuberculosis in one patient, no opportunistic infections were documented during an AIDS Clinical Trials Group (ACTG) study. There were no reports of liver toxicity or new cancers during the extended follow-up period.
   
• In one phase IIb study people taking vicriviroc were no more likely to have side effects than people taking a placebo.
   
• Studies are ongoing or being planned to determine what side effects may be associated with vicriviroc.

Who should not take vicriviroc?

•  It is not known whether vicriviroc will harm an unborn baby. It is very important to treat HIV/AIDS during pregnancy to reduce the risk of infecting your baby. Talk to your doctor about your treatment options.
   
•  It is not known whether vicriviroc passes into breast milk and what effect it may have on a nursing baby. To prevent transmission of the virus to uninfected babies, it is recommended that HIV-positive mothers not breast-feed.

Where can I learn more about clinical trials of vicriviroc?

• If you would like to find out if you are eligible for any clinical trials that include vicriviroc, there is an interactive web site run by ACRIA, the AIDS Community Research Initiative of America.
   
• Another useful service for finding clinical trials is AIDSinfo.nih.gov, a site run by the U.S. National Institutes of Health. They have “health information specialists” you can talk to at their toll-free number at 1-800-HIV-0440 (1-800-448-0440).

• Fuzeon is a fusion inhibitor being manufactured by Trimeris and Hoffmann-La Roche. It was approved by the U.S. Food and Drug Administration (FDA) in March, 2003. Fuzeon is approved for HIV-positive people who have tried other anti-HIV drugs in the past and are unable to keep their viral loads undetectable using drugs that are currently available. It has not yet been approved for HIV-positive people who are starting anti-HIV drug treatment for the first time.
   
• Fuzeon must be used in combination with other anti-HIV drugs.

What is Fuzeon?

• Fuzeon is an anti-HIV medication. It is in a category of HIV medicines called fusion inhibitors, or more broadly, entry inhibitors.
   
• Fuzeon binds to a protein on HIV’s surface called gp41. Once it does this, HIV cannot successfully bind with the surface of T-cells, thus preventing the virus from infecting healthy cells.
   
• Fuzeon will most likely need to be used in combination with other anti-HIV drugs.

What is already known about Fuzeon?

•  Because of its fragile structure (it is a peptide), Fuzeon cannot be taken by mouth. It is currently given in an injectable form and requires two shots a day: one in the morning and one 12 hours later at night. Each shot contains 90mg of Fuzeon. Small hypodermic needles, similar to those used by diabetics to inject insulin, are used.Injecting Fuzeon is actually a multi-step process. A month’s supply of Fuzeon comes in boxes containing 120 little vials. 60 vials contain Fuzeon powder and 60 vials contain sterile water (one Fuzeon vial and one sterile water vial, twice a day). Before Fuzeon can be injected, you will need to use the hypodermic needle to remove sterile water from one vial and inject it into a vial containing Fuzeon powder. Once you have mixed a single dose—a process called “reconstitution”—the liquid is injected directly under the skin using the hypodermic needle. The mixing and injecting of Fuzeon can be a difficult and time-consuming process and must be done correctly to ensure that the drug is effective. Be sure that your doctor or nurse carefully explains how Fuzeon needs to be mixed and injected correctly.
• For HIV-positive people considering, starting, or currently using Fuzeon, Roche offers two helpful and free support programs.The Fuzeon Connections program offers an assistance hotline, staffed by nurses seven days a week, to help answer questions, including how to prepare and inject Fuzeon. The hotline can be reached by calling: 1-877-4FUZEON (438-9366).

  Roche also offers the Nurse-to-Patient Connections program, also available by calling 1-877-4FUZEON, providing personalized direct assistance. HIV-positive people living in most major U.S. metropolitan areas can request a home visit by a nurse educator, to learn more about preparing and injecting Fuzeon, proper use of the syringes that come with Fuzeon, and to help manage injection anxiety. Alternatively, arrangements can be made to meet the nurse educator at a healthcare provider’s office or another location.
   

• The manufacturers of Fuzeon are experimenting with a needle-free injection device called Biojector 2000 (B2000). In a statement released by the company in October 2006, administration with B2000 achieves similar blood levels of Fuzeon compared to standard needle-based administration. However, before it can be approved, the FDA is evaluating reports of bruises (hematomas) and nerve damage that have been seen in some patients using the needle-free injection device.
   
•  Fuzeon might interact with other medications, including those used to treat HIV. It is important that your personal physician and/or the research nurse or study investigator be aware of all drugs you are taking, including those you buy without a prescription.
   
• Fuzeon holds promise for HIV-positive patients who have taken (and failed) numerous anti-HIV drugs in the past. Because Fuzeon targets HIV differently than currently available drugs, chances are that most people living with the virus—regardless of the medications they have taken in the past—will likely benefit from using Fuzeon. Two large clinical trials have determined that Fuzeon, when combined with other drugs, is effective for patients who have failed other anti-HIV drugs in the past. However, Fuzeon worked best when it was combined with at least two other drugs that the virus was sensitive to (patients who used Fuzeon in combination with drugs that their virus was highly resistant to did not experience decreases in their viral load for very long). In this way, it is best to use drug-resistance testing to determine which drugs your virus is sensitive to and to use the results of testing to figure out which are the best anti-HIV drugs to combine with Fuzeon.
   
• It is also expected that Fuzeon, when combined with other anti-HIV drugs, will have strong activity against HIV in people who have never taken anti-HIV medications in the past. According to early results from one study, Fuzeon taken alone reduced viral load from anywhere between 30% to more than 90% in patients who had not taken any other anti-HIV drugs in the past. Fuzeon is not yet approved by the FDA for HIV-positive people who are new to anti-HIV treatment. HIV can become resistant to Fuzeon, particularly if it (combined with other anti-HIV drugs) is not able to reduce viral load to undetectable levels or keep viral load undetectable. Drug-resistance tests are able to determine if your virus has become less sensitive to Fuzeon, in the event that your viral load becomes detectable or increases while you are taking this drug.

What is known about side effects?

• Injection site reactions — symptoms that occur at the spot where you inject Fuzeon — have been the most common side effect reported in studies. Reactions may include pain and discomfort, hardened skin, redness, bumps, itching and swelling. Most reactions are mild, but occasionally may be sever. While 98% of patients that take Fuzeon report injection site reactions, only 4% have stopped taking the drug because of this skin irritation.
   
• A reaction at one skin injection site usually lasts for less than 7 days. Injection site reactions may be worse when injections are given again in the same place on the body, or when the injection is given deeper than it should be (for example, into the muscle).
   
• While Biojector 2000 (B2000), the experimental needle-free device, has been shown to cause fewer injection site reactions in clinical trials, it has also been shown to cause significant side effects of its own. In some patients using the device, B2000 has caused long-lasting nerve pain and bruising at the sites of injection. To reduce the risk of these problems, it is recommended that Fuzeon not be injected at certain sites, including the elbow, knee, groin, parts of the buttocks, or near moles, scars, burns, tattoos, above blood vessels, or near the belly button. The best sites to use B2000 are the abdomen, upper arm, and outer thigh.
   
•  In clinical trials, patients taking Fuzeon with other HIV medicines got bacterial pneumonia more often than patients not receiving Fuzeon. It is unclear if this was related to the use of Fuzeon. You should contact your healthcare provider right away if you have a cough, fever or trouble breathing.
   
•  Although very rare, allergic reactions have been seen with Fuzeon and can occur again the drug is restarted. Symptoms can include rash, fever, nausea and vomiting, chills, shaking, low blood pressure and increased liver enzymes.
   
• Other side effects may occur as a result of taking Fuzeon, including peripheral neuropathy, insomnia, depression, decreased appetite, fatigue, muscle pain, constipation, and pancreas problems.

Can pregnant women take Fuzeon?

• Fuzeon is classified by the FDA as a pregnancy category B drug. Pregnancy category B means that animal studies have failed to demonstrate a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women. HIV-positive women who become pregnant should discuss the benefits and possible side effects of anti-HIV treatment to help protect their babies from HIV (see our lesson called Family Planning, Pregnancy & HIV).
   
•  It is not known whether Fuzeon passes into breast milk and what effect it may have on a nursing baby. To prevent transmission of the virus to uninfected babies, it is recommended that HIV-positive mothers not breast-feed.

Where can I learn more about clinical trials of Fuzeon?

• If you would like to find out if you are eligible for any clinical trials that include Fuzeon, there is an interactive web site run by ACRIA, the AIDS Community Research Initiative of America.
   
• Another useful service for finding clinical trials is AIDSinfo.nih.gov, a site run by the U.S. National Institutes of Health. They have “health information specialists” you can talk to at their toll-free number at 1-800-HIV-0440 (1-800-448-0440).

• Viracept is an anti-HIV medication. It is in a category of HIV medications called protease inhibitors (PIs). Viracept prevents T-cells that have been infected with HIV from producing new HIV.
   
• Viracept is manufactured by Agouron Pharmaceuticals, a division of Pfizer Inc. The U.S. Food and Drug Administration (FDA) approved it for the treatment of HIV infection in 1997.

What is known about Viracept?

• Viracept can be taken either three times a day or twice a day:
   
  • The three-times-daily Viracept dosing schedule involves taking three 250mg tablets every eight hours.
     
  • The twice-daily Viracept dosing schedule involves taking two 625mg tablets every 12 hours. An alternative option is to take five 250mg tablets every 12 hours. The twice-daily dosing schedule, using the 625mg tablets, is preferred by many healthcare providers, as it involves taking the fewest number of pills the fewest number of times a day.
     
•  Viracept should be taken with food, preferably a full nutritious meal (e.g., breakfast and dinner). Taking Viracept with food increases the amount of drug in the bloodstream, which could make Viracept more effective against the virus.
   
• Viracept is approved for HIV-positive children two years of age and older (the dose depends on body weight and must be taken with food). A September 2007 warning from the FDA, recommending that HIV-positive children avoid Viracept due to the discovery of a possible cancer-causing impurity called EMS, has since been lifted. To learn about treatment options for children, click here.
   
• Clinical trials have determined that Viracept is safe and effective when combined with other drugs, most notably two nucleoside reverse transcriptase inhibitors (NRTIs).
   
• For HIV-positive adults beginning anti-HIV drug therapy for the first time, Viracept is listed as a “possible” protease inhibitor option by the United States Department of Health and Human Services in its treatment guidelines. This means that it can be used, but because of lingering concerns about effectiveness and/or safety, it is considered to be inferior to “preferred” or “alternative” protease inhibitor options (e.g., Norvir-boosted Reyataz, Norvir-boosted Lexiva, or Kaletra). To learn more about these recommendations and options, click here.
   
• If your viral load becomes detectable while taking a drug regimen that contains Viracept, your doctor can order a drug-resistance test to see which drugs your virus are becoming less sensitive to.
   
• Many of the currently available protease inhibitors are affected by cross-resistance. This means that, if you’ve tried and failed a drug regimen in the past that contained a protease inhibitor, your virus might be resistant to Viracept. Similarly, if you take an anti-HIV drug regimen that contains Viracept and your virus becomes resistant to the drug, your virus might also be resistant to many of the other protease inhibitors available. This is why it is very important to use drug-resistance testing to determine which drugs your virus are no longer responding to if you experience a rebound in your viral load while taking an anti-HIV drug regimen. Drug-resistance testing can also help you figure out which protease inhibitors your virus is still sensitive to.

What about drug interactions?

•  Viracept is broken down (metabolized) by the liver, like many medications used to treat HIV and AIDS. This means that Viracept can interact with other medications. Viracept can lower or raise the levels of other medications in the body. Similarly, other medications can lower or raise the levels of Viracept in the body. While many interactions are not a problem, some can cause your medications to be less effective or increase the risk of side effects.
   
• Tell your doctors and pharmacists about all medicines you take. This includes those you buy over-the-counter and herbal or natural remedies, such as St. John’s Wort. Bring all your medicines when you see a doctor, or make a list of their names, how much you take, and how often you take them. Your doctor can then tell you if you need to change the dosages of any of your medications.
   
•  The following medications should not be taken while you are being treated with Viracept:
  Acid reflux/heartburn medications: Propulsid (cisapride)
  Antibiotics: Priftin (rifapentine) and Rifadin (rifampin)
  Antimigraine medications: Ergostat, Cafergot, Ercaf, Wigraine (ergotamine) or D.H.E. 45 (dihydroergotamine)
  Antihistamines: Hismanal (astemizole) or Seldane (terfenadine)
  Cholesterol-lowering drugs (statins): Zocor (simvastatin ) and Mevacor (lovastatin)
  Antipsychotics: Orap (pimozide)
  Sedatives: Versed (midazolam) and Halcion (triazolam)
   
• Anticonvulsants, such as Tegretol (carbamazepine), phenobarbital, and Dilantin (phenytoin), may decrease the amount of Viracept in the bloodstream. It might be necessary to increase your dose of Viracept if you are taking any of these drugs.
   
• Anti-HIV protease inhibitors can interact with Viracept. We know that Norvir (ritonavir) increases the amount of Viracept in the bloodstream (the recommended dose is two or three 250mg Viracept tablets combined with four 100mg Norvir capsules). Kaletra (lopinavir/ritonavir) can also increase Viracept levels, but Viracept decreases blood levels of the lopinavir in Kaletra (no dose has been recommended). Viracept increases Agenerase (amprenavir) and Lexiva (fosamprenavir) levels in the bloodstream (no dose has been recommended). When Viracept is combined with Invirase (saquinavir), blood levels of both drugs are increased (the dose of Invirase should be 1200mg twice daily and the dose of Viracept should be 1250mg twice daily, with no Norvir added). Viracept also increases Crixivan (indinavir) levels, but no dose has been confirmed.
   
• Anti-HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs) can also interact with Viracept. Sustiva (efavirenz), Viramune (nevirapine), and Rescriptor (delavirdine) can all increase Viracept levels in the bloodstream, although it’s probably not necessary to change the doses.
   
• Viracept can interact with some medications used to treat TB, MAC and other bacterial infections. Rifadin (rifampin) can decrease Viracept levels in the bloodstream; these two drugs should not be used together. Viracept can increase Mycobutin (rifabutin) levels and Mycobutin can decrease Viracept levels (the Mycobutin dose should be reduced to 150mg every day and the Viracept dose should be increased to four 250mg tablets three times a day). It is not known if Viracept effects Biaxin (clarithromycin) levels in the bloodstream.
   
• Viracept decreases the amount of oral contraceptives (taken by women to help avoid pregnancy) in the bloodstream. This means that there may be a higher risk of becoming pregnant if Viracept and oral contraceptives are taken at the same time. To reduce the risk of pregnancy, barrier protection (e.g., condoms) should be used.
   
• Methadone, commonly used to treat drug addiction, can interact with Viracept. Methadone levels in the bloodstream can decrease when combined with Viracept. Because of this, it might be necessary to increase the dose of methadone.
   
• Cholesterol-lowering drugs, also known as “statins,” can interact with Viracept. There are two statins that should not be used with Viracept: Zocor (simvastatin) and Mevacor (lovastatin). Levels of these two drugs can become significantly increased in the bloodstream if they are combined with Viracept, which increases the risk of side effects. The two statins that are considered to be the safest in combination with Viracept are Pravachol (pravastatin) and Lescol (fluvastatin). It is also possible to take Viracept with Lipitor (atorvastatin), although Viracept can increase Lipitor levels in the bloodstream. If Lipitor is prescribed, it’s best to begin treatment with the lowest possible dose of the drug and then increase the dose if necessary. Little is known about the newest statin, Crestor (rosuvastatin), although it is not expected to have any serious drug interactions with Viracept or the other protease inhibitors.
   
• Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil) levels in the bloodstream likely increase when combined with Viracept. In turn, it is best to use a lower dose of these drugs in order to reduce the risk of side effects.
   
•  Herbal products can also interact with Viracept. St. John’s wort should not be used with Viracept, since it can greatly reduce the amount of Viracept in the bloodstream. HIV-positive people should also be cautious about using garlic supplements or milk thistle with Viracept—test tube studies suggest that both herbal products can interact with the same liver enzyme system (cytochrome P450 3A4) responsible for metabolizing Viracept. This may alter the amount of Viracept in the bloodstream. These and other herbal products should be used with caution, until further studies are conducted.
   
• A number of other negative drug interactions are possible if Viracept is combined with Norvir (ritonavir). To learn more about these drug interactions, click here.

What about side effects?

• Diarrhea is the most common side effect of Viracept. To learn some tips and tricks that can help reduce the severity of diarrhea, click here.
   
• Other short-term side effects include appetite loss, headaches, feeling crummy (malaise), nausea, and vomiting. Very often, these side effects improve within a few months/weeks of starting Viracept.
   
• Anti-HIV drug regimens containing protease inhibitors, including Viracept, can cause increased fat levels (cholesterol and triglycerides) in the blood, abnormal body-shape changes (lipodystrophy; including increased fat around the abdomen, breasts, and back of the neck, as well as decreased fat in the face, arms, and legs), and diabetes. These side effects of anti-HIV drug therapy are reviewed in our lessons on Lipodystrophy, Facial Lipoatrophy, and Risks To Your Heart (Hyperlipidemia).

Can pregnant women take Viracept?

• Viracept is classified by the FDA as a pregnancy category B drug. Pregnancy category B means that animal studies have failed to demonstrate a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women. A September 2007 warning from the FDA, urging HIV-positive pregnant women to avoid Viracept due to the discovery of a possible cancer-causing impurity called EMS, has since been lifted. To learn more about treatment options during pregnancy, click here.
   
• It is not known whether Viracept passes into breast milk and what effects it may have on a nursing baby. However, to prevent HIV transmission of the virus to uninfected babies, it is recommended that HIV-positive mothers not breast-feed.

Who should not take Viracept?

•  Before taking this medication, tell your doctor if you have kidney disease or liver disease. You may not be able to take Viracept, or you may require a dosage adjustment or special monitoring during treatment if you have any of these conditions.
   

Where can I learn more about clinical trials that are using Viracept?

• If you would like to find out if you are eligible for any clinical trials that include Viracept, there is an interactive web site run by ACRIA, the AIDS Community Research Initiative of America.
   
• Another useful service for finding clinical trials is AIDSinfo.nih.gov, a site run by the U.S. National Institutes of Health. They have “health information specialists” you can talk to at their toll-free number at 1-800-HIV-0440 (1-800-448-0440).