Antiretroviral agents/therapy adverse effects

The development of antiretroviral therapy has been a major challenge since the discovery of the human inununodeficiency virus (HIV). Early successes with nucleoside and non-nucleoside reverse transcriptase (RT) inhibitors, as well as the development of protease inhibitors have facilitated, in recent years, a highly active antiretroviral therapy (HAART), where a combination of drugs is simultaneously administered. In spite of significant improvements in the morbidity and mortality of HIV-infected patients, the rapid appearance of resistant HIV-variants, as well as adverse effects and high cost of contemporary drugs necessitate the continuous development of independent classes of anti-HIV agents. ... 

In addition to knowledge about the clinical efficacy, adverse effect profile, and likelihood of emergence of resistance, the physician caring for an HIV-infected patient must be well versed in basic pharmacokinetics as well. Such patients are frequently taking multiple medications, including combinations of antiretroviral agents, prophylaxis or treatment for opportunistic infections, and opioid pain medications or methadone for maintenance therapy. 

HB V. This agent is also active against HIV but requires higher (125 mg daily) doses for treatment. Consequently, the use of adefovir in HBV patients coinfected with HIV may induce antiretroviral resistance. However, in contrast to lamivudine, the long-term use of adefovir has not been associated with the development of resistance in HBV. Adefovir is generally well tolerated with primary adverse effects including headache and abdominal pain. Nephrotoxicity is associated with adefovir and appears to be a dose-related effect. The incidence of nephrotoxicity defined as a 0.5-mg/dL increase in serum creatinine has not been noted in patients treated with 10 mg for 48 weeks. In contrast, a 120-mg daily dose of adefovir was associated with nephrotoxicity in 35% of patients with 48 weeks of therapy. ... 

Lipodystrophy syndrome - insulin resistance, hyperglycaemia, fat redistribution and raised lipid levels as adverse effect of antiretroviral therapy Lipolysis - break down of lipid LOCA - low osmolar contrast agent... 

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