Common Adverse Effects of Antiretroviral Therapy for HIV Disease.
Summary of "Common Adverse Effects of Antiretroviral Therapy for HIV Disease."
Family physicians are treating patients infected with human immunodeficiency virus in their practices more often. Long-term complications of this disease are multifactorial and can be related to the virus itself or to adverse effects of antiretroviral therapy. Each drug class has side effects: nucleoside/nucleotide reverse transcriptase inhibitors are associated with lactic acidosis, lipodystrophy, and hyperlipidemia; non-nucleoside reverse transcriptase inhibitors are associated with neuropsychiatric symptoms, rash, liver toxicity, and lipid abnormalities; and protease inhibitors are associated with gastrointestinal intolerance and glucose and lipid abnormalities. The entry inhibitor maraviroc and the integrase inhibitor raltegravir have been approved for treatment-naive and treatment-experienced patients. Maraviroc is associated with bronchitis, nasopharyngitis, and esophageal candidiasis. Adverse effects of raltegravir are comparable to those experienced with placebo, with the exception of increased risk of myopathy and rhabdomyolysis. Information about drug interactions for both of these medications is limited. Non-nucleoside reverse transcriptase inhibitors and protease inhibitors are primarily metabolized through the cytochrome P450 system, and as a result have numerous drug-drug interactions. Monitoring for adverse effects of antiretroviral therapy includes a complete blood count and comprehensive metabolic profile every three to six months. A lipid profile and urinalysis for proteinuria should be per- formed annually. Dual energy x-ray absorptiometry should be considered in patients older than 50 years. Long-term morbidity related to antiretroviral therapy includes liver, renal, glucose, and lipid abnormalities, and cardiovascular and bone disease. With some exceptions for lipid management, these morbidities can be managed as in the general population.
Affiliation
University of Missouri School of Medicine, Columbia, MO, USA.
Journal Details
This article was published in the following journal.
Name: American family physician
ISSN: 1532-0650
Pages: 1443-51
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21671545
- DOI: http://dx.doi.org/
Medical and Biotech [MESH] Definitions
Hiv-associated Lipodystrophy Syndrome
Defective metabolism leading to fat maldistribution in patients infected with HIV. The etiology appears to be multifactorial and probably involves some combination of infection-induced alterations in metabolism, direct effects of antiretroviral therapy, and patient-related factors.
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