[Frontiers in Bioscience 14, 1785-1792, January 1, 2009]

Adverse drug reactions to antiretroviral medication

Bernardino Roca

Hospital General of Castellon, University of Valencia, Spain

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Hypersensitivity reactions
3.1. Hypersensitivity to nevirapine and other NNRTIs
3.2. Hypersensitivity to abacavir
3.3. Hypersensitivity to other antiretrovirals
3.4. Treatment of hypersensitivity reactions
4. Hyperlactatemia-steatosis syndrome
5. Liver toxicity
6. Pancreatitis
7. Gastrointestinal intolerance
8. Nervous system toxicity
8.1. Central nervous system side effects of efavirenz
8.2. Ascending neuromuscular weakness
8.3. Peripheral neuropathy
9. Hematologic toxicity
9.1. Bone marrow suppression
9.2. Excess bleeding
10. Urinary tract toxicity
10.1. Urolithiasis
10.2. Nephrotoxicity
11. Metabolic and cardiovascular side effects
12. Lipodystrophy
12.1. Lipoatrophy
12.2. Lipohypertrophy
13. Osteopenia and osteonecrosis
14. Immune reconstitution
15. Local reactions
16. References

1. ABSTRACT

Antiretroviral therapy has greatly improved prognosis of HIV infection, with a dramatic reduction of morbidity and mortality worldwide. Nevertheless, the condition is still a common cause of death in many underdeveloped countries, where effective treatment is not always unavailable. More than 20 drugs active against HIV are commercially available, which belong to one of four groups: nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and fusion/entry inhibitors. In the near future new drugs are expected, including those of a novel group, the integrase inhibitors. To avoid viral resistance, combinations of the drugs must always be used in clinical practice. Adverse reactions are common with antiretrovirals, and they are an important cause of medication non-adherence and suboptimal control of HIV infection. In this article we review the most relevant of those toxicities.