Antiretroviral chemotherapy in HIV infection

There are six main categories of antiretroviral drugs used in HIV infection:

• nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs):
  • AZT (zidovudine)
  • ddI (didanosine)
  • ddC (zalcitabine)
  • d4T (stavudine)
  • 3TC (lamivudine)
  • abacavir
• non-nucleoside analogue inhibitors of reverse transcriptase (NNRTIs):
  • etravirine
  • delavirdine
  • nevirapine
  • efavirenz
• integrase inhibitors
  • raltegravir (RAL)
  • elvitegravir (EVG)
• protease inhibitors (PIs):
  • amprenavir (APV, Agenerase)
  • atazanavir (ATZ, Reyataz)
  • saquinavir
  • ritonavir
  • indinavir
  • nelfinavir
  • lopinavir
• fusion inhibitors – prevents fusion of viral membrane with the cell membrane
  • enfuvirtide T-20 (1)
• coreceptor antagonists

Some serious or unusual side effects of antiretroviral therapy are:

• NRTI’s – hypersensitivity, lactic acidosis and hepatomagaly, bone marrow suppression, pancreatitis, peripheral neuropathy, lipoatrophy
• NNRTI’s – hypersensitivity hepatic toxicity, psychiatric problems
• PI’s – hepatic toxicity, hyperlipdaemia, lipodystrophy, type 2 diabetes, ureteric colic, nephrolithiasis (1)

Reference:

• (1) Arts EJ, Hazuda DJ. HIV-1 Antiretroviral Drug Therapy. Cold Spring Harbor Perspectives in Medicine. 2012;2(4):a007161
• (2) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2016. HIV in primary care. A practical guide for primary healthcare professionals in Europe.