Long-term complications of nucleoside reverse transcriptase inhibitor therapy

Area of Science:

• Internal Medicine
• Pharmacology
• Infectious Diseases

Background:

• Highly Active Antiretroviral Therapy (HAART) has transformed HIV/AIDS management, reducing mortality.
• Long-term use of HAART, particularly nucleoside reverse transcriptase inhibitors (NRTIs), is associated with emerging toxicities.
• These toxicities can lead to treatment non-adherence and regimen changes.

Purpose of the Study:

• To review the major long-term complications associated with NRTI use in HIV patients.
• To discuss the mechanisms underlying NRTI-induced toxicities.
• To explore differential effects and management strategies for NRTI-related adverse events.

Main Methods:

• Literature review of studies on NRTI-associated toxicities.
• Discussion of pathogenetic mechanisms of NRTI-induced complications.
• Analysis of clinical data regarding NRTI toxicity profiles and management.

Main Results:

• NRTI use is linked to significant long-term toxicities including hyperlactatemia, lactic acidosis, hepatic steatosis, and other hepatotoxicities.
• Other observed complications include pancreatitis, lipodystrophy, lipoatrophy, neuropathy, and hematologic toxicities.
• The specific toxicities and their severity vary among different NRTIs.

Conclusions:

• Understanding NRTI-related toxicities is crucial for optimizing HIV treatment regimens.
• Monitoring for and managing these long-term complications can improve patient adherence and outcomes.
• Further research into NRTI mechanisms and alternative therapies is warranted.