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Switching effective antiretroviral therapy: a review
Henning Drechsler1, William G Powderly
1Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Summary
Switching antiretroviral therapy drugs can be safe for patients with viral suppression. Some metabolic issues may reverse, but body shape changes often persist, requiring further research.
Area of Science:
- HIV/AIDS treatment
- Pharmacology
- Metabolic disorders
Background:
- Antiretroviral therapy (ART) can cause long-term metabolic toxicity and body-shape changes.
- Switching ART components is a strategy to mitigate these adverse effects.
- Thymidine analogue nucleosides, like stavudine, are increasingly investigated for substitution.
Purpose of the Study:
- To evaluate the virologic safety and efficacy of switching ART components.
- To assess the reversibility of metabolic disturbances and morphological abnormalities associated with ART.
- To review trends and identify needs for future research in ART-related toxicities.
Main Methods:
- Review of studies involving ART regimen substitutions.
- Analysis of outcomes related to viral suppression, metabolic parameters, and body-shape changes.
- Comparison of switching protease inhibitors versus thymidine analogue nucleosides.
Main Results:
- Switching ART is generally virologically safe in patients with sustained viral suppression.
- Metabolic disturbances like insulin resistance and dyslipidemia show potential for partial reversal.
- Substitution of protease inhibitors did not improve fat redistribution; switching thymidine analogues showed modest improvement in lipoatrophy.
Conclusions:
- ART regimen modification can be a safe strategy for managing treatment-related toxicities.
- Metabolic improvements are possible, but morphological changes like lipoatrophy may only partially resolve.
- Further large-scale, controlled studies are needed to standardize definitions and assess long-term outcomes.