Antiretroviral adverse drug reactions and their management.

Abstract

The 2010 South African ART guidelines recommend the use of tenofovir (TDF) and lamivudine (3TC) with efavirenz (EFV) or nevirapine (NVP) as first line therapy for naïve adults starting antiretroviral therapy.[1] Second-line therapy is determined by the NRTI choice in first line. Patients on a first line regimen with TDF will be prescribed lopinavir/ritonavir (LPV/r), zidovudine (AZT) and 3TC while patients on a first line regimen with AZT or d4t will receive lopinavir/ritonavir (LPV/r), tenofovir and 3TC. Other antiretrovirals commonly used in the private sector are abacavir (ABC), atazanavir/ritonavir (ATV/r) and the recently registered darunavir/ritonavir (DRV/r). Newer antiretrovirals, used for more treatment experienced patients, are still in the registration process, such as the second-generation NNRTI etravirine (ETV) and the integrase inhibitor raltegravir (RLT) These drugs may be prescribed for patients with limited treatment options subject to MCC approval on a case by case basis.

This article will discuss the common and serious adverse effects (AEs) related to the above antiretrovirals and the steps to take to avoid and manage these events. Table 1 summarises these AEs.