Antiretroviral Therapy—Associated Toxicities in the Resource-Poor World: The Challenge of a Limited Formulary

Toxicities related to antiretroviral therapy make long-term adherence to therapy difficult for patients and present challenges to providers, especially those in the resource-poor world who work with a limited formulary. In resource-poor settings, where limited drug options are the rule, when and how...

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Bibliographic Details
Published in:The Journal of infectious diseases 2007-12, Vol.196 (Supplement-3), p.S449-S456
Main Authors: Murphy, Richard A, Sunpath, Henry, Kuritzkes, Daniel R, Venter, Francois, Gandhi, Rajesh T
Format: Article
Language:English
Subjects:
Acquired Immunodeficiency Syndrome - drug therapy
Acquired Immunodeficiency Syndrome - economics
Acquired Immunodeficiency Syndrome - virology
AIDS
Anemia
Anti-HIV Agents - adverse effects
Anti-HIV Agents - economics
Anti-Retroviral Agents - adverse effects
Anti-Retroviral Agents - economics
Antiretrovirals
Biological and medical sciences
Developing Countries
Hepatitis B virus
HIV infections
Human immunodeficiency virus
Human viral diseases
Humans
Hypersensitive response
Infections
Infectious diseases
Lactic acidosis
Medical sciences
Nucleosides
Symptoms
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:Toxicities related to antiretroviral therapy make long-term adherence to therapy difficult for patients and present challenges to providers, especially those in the resource-poor world who work with a limited formulary. In resource-poor settings, where limited drug options are the rule, when and how to change therapy are especially difficult problems. Drugs such as stavudine and didanosine are associated with serious metabolic complications, such as lactic acidosis, pancreatitis, and peripheral neuropathy. Antiretroviral agents associated with fewer metabolic effects, such as tenofovir and abacavir, remain widely unavailable. Because the current formulary restrictions appear to be unlikely to change quickly, providers in resource-poor countries must be familiar with the common adverse events—including metabolic complications, hypersensitivity reactions, anemia, and liver enzyme abnormalities—and must understand how to manage them with what is locally available. Most importantly, to avoid drug toxicities, a larger formulary is needed in resource-poor settings, and this must be a high priority for policy makers and health care professionals involved in treating human immunodeficiency virus infection globally.
ISSN:0022-1899
1537-6613
DOI:10.1086/521112