Antiretroviral medications for HIV: Identification and Adverse Reactions
Antiretroviral therapy (ART) is a combination of at least three different drugs from at least two drug classes, used to reduce the amount of HIV in the body. This treatment is recommended for all people living with HIV, regardless of how long they have had the virus or how healthy they are currently. With ART, many people with HIV can live a life span comparable to those without HIV, thanks to advances in the therapy.
ART can help prevent complications of HIV and keep the virus from multiplying, allowing the body to generate more helpful white blood cells. However, like any medication, ART can have side effects, which vary depending on the medication used.
**Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)**
Common side effects of NRTIs include fatigue, headache, nausea, diarrhea, and appetite loss. Some NRTIs, such as abacavir, carry a risk of serious hypersensitivity (allergic) reactions, which can be life-threatening and require genetic testing before use. Milder symptoms may include mitochondrial toxicity leading to peripheral neuropathy, lactic acidosis, and lipodystrophy in some cases.
**Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)**
Typical side effects of NNRTIs include rash, headache, dizziness, nausea, and mood changes. Some NNRTIs, like nevirapine and efavirenz, are associated with hypersensitivity reactions and neuropsychiatric symptoms such as vivid dreams and mood alterations. Hepatotoxicity can also occur, especially with nevirapine.
**Protease Inhibitors (PIs)**
Common adverse effects of PIs are gastrointestinal symptoms like nausea, diarrhea, and abdominal discomfort. PIs may cause metabolic disturbances, including insulin resistance, hyperlipidemia, and lipodystrophy. Hypersensitivity reactions are less common but possible with atazanavir and darunavir. These drugs have significant drug-drug interactions due to CYP3A4 metabolism.
**Entry Inhibitors (e.g., CCR5 antagonists like maraviroc)**
Side effects may include rash, fever, chills, nausea, and injection site reactions for injectable forms. Hypersensitivity and liver toxicity have been reported rarely. Some entry inhibitors can cause hypotension or elevated liver enzymes.
**Integrase Strand Transfer Inhibitors (INSTIs)**
Generally well tolerated, INSTIs may cause headache, nausea, and diarrhea. Rare hypersensitivity or allergic reactions have been reported with drugs like dolutegravir and raltegravir. Some may cause insomnia or weight gain.
Long-term side effects of ART may include depression, diabetes, heart disease, kidney damage, liver damage, nerve damage, weak bones, osteoporosis, and elevated cholesterol levels. People should be vigilant for signs of allergic reactions like rash plus fever and seek immediate medical attention if they occur.
In clinical practice, managing ART side effects involves monitoring, switching drugs if needed, and supportive care such as taking medications with food or at different times to reduce discomfort. Resources are available to help people cover the costs of HIV treatment and follow an ART regimen. Stopping ART without consulting a healthcare professional can cause HIV to multiply rapidly, increasing the risk of illness and infection.
This overview is drawn from recent clinical data and expert summaries of ART side effects. People taking ART should inform their healthcare professional about other medications and supplements they are taking, as certain HIV drugs may make hormonal birth control less effective, and people may want to consider using a different method to prevent pregnancy.
[1] References omitted for brevity.
- Antiretroviral therapy (ART) is a combination of three different drugs, recommended for all people living with HIV, to reduce HIV in the body and prevent its multiplication.
- With ART, many people with HIV can live a life span comparable to those without HIV, due to advances in the therapy.
- ART can help prevent complications of HIV and allow the body to generate more helpful white blood cells.
- Common side effects of NRTIs include fatigue, headache, nausea, diarrhea, and appetite loss.
- Some NRTIs, like abacavir, carry a risk of serious hypersensitivity reactions.
- Milder symptoms of NRTIs may include mitochondrial toxicity leading to peripheral neuropathy, lactic acidosis, and lipodystrophy in some cases.
- Typical side effects of NNRTIs include rash, headache, dizziness, nausea, and mood changes.
- Some NNRTIs, like nevirapine and efavirenz, are associated with hypersensitivity reactions and neuropsychiatric symptoms.
- Hepatotoxicity can occur, especially with nevirapine.
- Common adverse effects of PIs are gastrointestinal symptoms like nausea, diarrhea, and abdominal discomfort.
- PIs may cause metabolic disturbances, including insulin resistance, hyperlipidemia, and lipodystrophy.
- Hypersensitivity reactions are less common but possible with atazanavir and darunavir.
- Side effects of entry inhibitors may include rash, fever, chills, nausea, and injection site reactions.
- Long-term side effects of ART may include depression, diabetes, heart disease, kidney damage, liver damage, nerve damage, weak bones, osteoporosis, and elevated cholesterol levels.
- People should be vigilant for signs of allergic reactions and seek immediate medical attention if they occur.
- In clinical practice, managing ART side effects involves monitoring, switching drugs if needed, and supportive care.
- Resources are available to help people cover the costs of HIV treatment and follow an ART regimen.
- People taking ART should inform their healthcare professional about other medications and supplements they are taking, as certain HIV drugs may make hormonal birth control less effective.
