Adverse effects of antiretroviral therapy for HIV infection: A review of selected topics

Royal Perth Hospital and Murdoch University, Centre for Clinical Immunology and Biomedical Statistics, 2nd Floor, North Block, Wellington Street, Perth, 6000, Western Australia, Australia.
Expert Opinion on Drug Safety (Impact Factor: 2.91). 04/2005; 4(2):201-18. DOI: 10.1517/14740338.4.2.201
Source: PubMed


In the current era of HIV treatment, the toxicity profiles of antiretroviral drugs have increasingly emerged as a basis for selecting initial antiretroviral regimens as well as a reason for switching therapy in treatment-experienced patients. In this respect, an intensive research effort involving clinical research as well as basic science research over the past six years, has focused on the cluster of metabolic and body composition abnormalities that have come to be termed the 'lipodystrophy syndrome'. These data have now provided a clear and clinically relevant understanding of the individual profiles of drugs within the nucleoside analogue reverse transcriptase inhibitor , HIV protease inhibitor and non-nucleoside analogue reverse transcriptase inhibitor drug classes, and have provided a rational basis for assessing and monitoring these adverse effects in clinical practice. In this review, current and emerging drug toxicities are considered with an emphasis on lipodystrophy complications.

9 Reads
  • Source
    • "Viral clearance from other reservoirs, such as from chronically infected macrophages, is also difficult since reverse transcriptase inhibitors are usually ineffective and protease inhibitors have significantly lower activities in these cells than in lymphocytes.22,23 Moreover, emergence of many side effects may require the cessation of treatment.24 Furthermore, the development of many types of resistance, related to the extreme mutability of the virus and in part to treatment interruptions, has been described in the literature.25–28 "
    [Show abstract] [Hide abstract]
    ABSTRACT: The introduction of highly active antiretroviral therapy (HAART) in 1996 has transformed a lethal disease to a chronic pathology with a dramatic decrease in mortality and morbidity of AIDS-related symptoms in infected patients. However, HAART has not allowed the cure of HIV infection, the main obstacle to HIV eradication being the existence of quiescent reservoirs. Several other problems have been encountered with HAART (such as side effects, adherence to medication, emergence of resistance and cost of treatment), and these motivate the search for new ways to treat these patients. Recent advances hold promise for the ultimate cure of HIV infection, which is the topic of this review. Besides these new strategies aiming to eliminate the virus, efforts must be made to improve current HAART. We believe that the cure of HIV infection will not be attained in the short term and that a strategy based on purging the reservoirs has to be associated with an aggressive HAART strategy.
    Journal of Antimicrobial Chemotherapy 02/2012; 67(5):1063-74. DOI:10.1093/jac/dkr599 · 5.31 Impact Factor
  • Source
    • "Metabolic abnormalities, including insulin resistance and elevated blood lipids (Kino & Chrousos, 2003; Sekhar et al., 2004), may accompany morphologic changes and contribute to a range of morbidities, most notably premature myocardial infarction and stroke (Barbaro, 2003; Barbaro et al., 2003; Colagreco, 2004; Cotter & Torriani, 2004; Grinspoon & Carr, 2005; Sekhar et al., 2004). The prevalence, etiology, diagnosis and treatment of lipodystrophy have been widely examined (Belloso et al., 2003; Carr, 2003; Hirsch & Battegay, 2002; Manfredi et al., 2004; Nolan et al., 2005). A number of publications recommend management strategies (Chen et al., 2002; Cofrancesco et al., 2004; Engelson, 2003a; Green, 2002; Moyle et al., 2003; Orentreich & Leone, 2004; Piliero et al., 2003; Sattler, 2003; Wohl, 2004), however, few include any consideration of accompanying psychosocial "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study was conducted to identify and describe the perceived morphologic changes of body fat redistribution and related distress among persons taking combination antiretroviral therapy. Six focus group interviews were conducted in four different US cities with men and women (n = 58) who reported antiretroviral-related symptoms of body fat loss and/or gain. Interview data were audiotaped, transcribed verbatim and systematically analysed using inductive techniques. Physical discomfort and impairment and psychological and social distress were reported across sex, sexual orientation and geographic subgroups. While participants acknowledged that antiretroviral drugs were keeping them alive, there was tension between the desire for life-sustaining treatment and optimal quality of life. Some participants engaged in harmful heath behaviours in an attempt to control bodily changes (e.g. non-adherence to antiretroviral regimen). Participants feared that fat loss represented disease progression and worried that visible changes would lead to unintentional disclosure of their HIV status. Although a potential source of support, healthcare providers were commonly perceived as ignoring and, in so doing, discrediting patient distress. Participants recognised the limitations of current lipodystrophy treatment options, yet a cure for the syndrome seemed less important to them in the short term than simply being listened to and the powerful, but oblique sources of distress addressed.
    AIDS Care 11/2006; 18(7):663-73. DOI:10.1080/09540120500287051 · 1.60 Impact Factor
  • Source

Show more