Adverse Effects of Antiretroviral Therapy

Introduction to Adverse Effects

The American College of Physicians recommends that patients on antiretroviral therapy be monitored for adverse effects, including acidosis láctica, neuropatía periférica, and lipoatrofia, with specific effects varying by agent 1, 2

The National Institutes of Health suggests that NRTIs can cause acidosis láctica with an incidence of 1.3 cases/1000 person-years of exposure, with high mortality, and immediate suspension is recommended if suspected 1, 2
The Centers for Disease Control and Prevention recommends that patients on zalcitabina, estavudina, and didanosina be monitored for neuropatía periférica, which may require medication change 1, 2
The World Health Organization notes that zidovudina is associated with bone marrow suppression, which may require substitution 1, 2
The European AIDS Clinical Society recommends that patients on tenofovir be monitored for renal toxicity, which can increase with combination with ritonavir-boosted protease inhibitors 4

The British HIV Association suggests that NNRTIs can cause rash and hepatotoxicity, with nevirapina being the most hepatotoxic and efavirenz causing unique neuropsychiatric effects that often require medication change 5, 7
The American Academy of HIV Medicine recommends that patients on nevirapina be monitored for hepatotoxicity, with an incidence of 12.5% and a risk of fulminant hepatic necrosis and death 8

The Infectious Diseases Society of America notes that PIs require pharmacokinetic enhancement and can cause multiple drug interactions, with metabolic effects including insulin resistance, diabetes, dyslipidemia, and lipodystrophy that generally require continuous management without suspension 1, 7, 6
The National Institutes of Health recommends that patients on PIs be monitored for gastrointestinal effects, including diarrhea, nausea, and vomiting, which are common but usually manageable 9

The European AIDS Clinical Society suggests that INSTIs cause the greatest weight gain among all antiretroviral classes, particularly bictegravir and dolutegravir, but have the most favorable safety profile with the fewest drug interactions 11, 6
The American College of Physicians recommends that patients on INSTIs be monitored for weight gain, with documentation of weight and BMI every 6 months 6

The Centers for Disease Control and Prevention recommends that patients on antiretroviral therapy be monitored for toxicity, with evaluation at least twice during the first month of therapy and every 3 months thereafter 3
The World Health Organization suggests that patients on NRTIs be monitored for renal function, bone mineral density, and lactate levels if symptomatic 4
The British HIV Association recommends that patients on NNRTIs be monitored for liver enzymes, particularly with nevirapina, every 2 weeks for 1 month, then monthly for 12 weeks 8
The Infectious Diseases Society of America notes that patients on PIs should be monitored for glucose, lipid profile, and liver function 9, 10
The European AIDS Clinical Society recommends that patients on INSTIs be monitored for weight and BMI every 6 months 6