Adverse Effects Associated With Antiretroviral Therapy and Potential Management Strategies

Abstract

A variety of adverse drug reactions (ADRs) affecting many organ systems may be observed with antiretroviral therapy (ARV), and they can be differentiated into short- and long- term effects, class effects, or individual drug effects. Commonly seen ADRs include dermatological reactions, associated with nonnucleoside reverse transcriptase inhibitors (NNRTIs) and some protease inhibitors (PIs), and gastrointestinal problems, a major side effect of PIs and of some nucleoside reverse transcriptase inhibitors (NRTIs). Metabolic complications are frequently reported in HIV-infected patients on ARV and often coexist. Lipodystrophy, hyperinsulinemia/hyperglycemia, and bone disorders (osteoporosis, osteonecrosis) are mainly associated with PIs, while lactic acidemia/acidosis are primarily a problem of NRTIs. Hyperlipidemia may be caused by almost all PIs, few NRTIs, and NNRTIs. All antiretroviral drug classes may cause both asymptomatic and symptomatic hepatotoxicity, although nevirapine is the agent most implicated in hepatic events. More drug-specific ADRs include nephrotoxicity (indinavir and tenofovir), central nervous system problems (efavirenz), hematological disturbances (zidovudine), and hypersensitivity reactions (abacavir). Anticipation of ADRs may influence a patient’s decision to delay ARV or to choose specific and potentially less active agents. Occurrence of ADRs may significantly impact a patient’s quality of life and drug adherence. Pharmacists counseling HIV-infected patients should be aware of common ADRs with ARV and potential management strategies.

Risk factors, management and outcomes of adverse drug reactions in adult patients on antiretrovirals at Kenyatta National Hospital, Nairobi

“…Zidovudine has been implicated as the most common cause of hematological toxicity (14,25,26). However, no association between regimens containing zidovudine and haematological disorders was found in our study, perhaps because the number of patients was too small.…”

Adverse Drug Reactions and Clinical Outcomes in Patients Initiated on Antiretroviral Therapy: A Prospective Cohort Study From Ethiopia

“…ADRs such as nausea reduce food intake and, subsequently, a gain in BMI. In addition, patients who took zidovudine-containing regimens, as reported elsewhere [26], as well as the unemployed, were more likely to develop severe ADRs in this sample. Studies in sub-Saharan patients [42], including our previous study [32], reported that eating insufficient food, which is more likely related with unemployment, exacerbated ADRs with ART.…”

“…Other studies had also reported NRTIs as a risk factor for the occurrence of gastrointestinal problems [26]. The overall prevalence of gastrointestinal complaints (54.5 %) was lower than reported in a cohort of Iranian patients (67.3 %), where 81 % of patients were taking a zidovudine-based regimen [24].…”

Adverse Drug Reactions to Antiretroviral Therapy (ART): Prospective Study in HIV Infected Adults in Sikasso (Mali)

“…Hepatic toxicity occurs in about one-third (1/3) of HIV-infected patients after initiation of therapy [8]. Metabolic complications are frequently reported, such as lipodystrophy, hyperinsulinemia/hyperglycemia and osteoporosis, osteonecrosis associated with Protease Inhibitors (PIs), and lactic acidosis with Nucleoside Reverse Transcriptase Inhibitors (NRTI) [7,9]. Dyslipidemia associated with an increased risk of cardiovascular disease is also reported in HIV-1 infected patients who receive ARV [10].…”

“…These adverse effects result in changes in biological parameters with often clinical manifestations [6], which can affect many organs of the body. The most common adverse reactions are dermatological reactions and Gastrointestinal (GI) disorders [7]. Hepatic toxicity occurs in about one-third (1/3) of HIV-infected patients after initiation of therapy [8].…”