The majority of patients taking antiretroviral therapy (ART) that includes drugs associated with long-term side-effects may have the option of switching to a novel regimen that uses newer and safer anti-HIV drugs, according to Australian research published in PLOS One. The single-site study showed that up to 89% of patients had the option of changing to a combination that includes three active newer agents with improved safety and side-effect profiles.
The drugs associated with long-term side-effects evaluated in this study comprise the core antiretroviral drugs prescribed to the majority of people taking antiretroviral treatment today. But the authors acknowledge “most of the regimens considered as ‘viable’ in this study have not been rigorously tested in clinical trials and might be regarded as unconventional.” Nevertheless, they stress “the growing interest in testing novel combinations of ART agents, which exclude nucleoside(tide) and older non-nucleoside reverser transcriptase inhibitors (N(t)RTIs and NNRTIs, respectively), as well as ritonavir (booster dose).” Most patients taking HIV therapy have an excellent life expectancy. However, there is concern about the safety and tolerability of many routinely used anti-HIV drugs.
Investigators at St Vincent’s Hospital, Sydney, Australia, called these the “RATE” drugs: ritonavir (Norvir), which is associated with drug interactions, diarrhoea and lipid disturbances; abacavir (Ziagen), which can involve a hypersensitivity reaction, has reduced potency at higher viral loads and may involve a risk of cardiovascular disease; tenofovir (Viread), which can cause bone and kidney problems; and efavirenz (Sustiva), associated with neuropsychiatric side-effects and increased lipids. Moreover, these drugs are usually used in combination, compounding their toxicity profiles.
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