Prescribing for patients taking antiretroviral therapy

Abstract

SUMMARY Current first-line antiretroviral therapy comprises a combination of drugs that are generally well tolerated. Adverse effects include hypersensitivity reactions, renal and liver toxicity, rhabdomyolysis, hyperlipidaemia, weight gain and neuropsychiatric disorders Most drug–drug interactions related to antiretroviral therapy involve drug absorption, metabolism or elimination. Some interactions may increase toxicity or reduce the effectiveness of antiretroviral therapy potentially resulting in treatment failure Routinely checking for adverse drug effects and potential drug–drug interactions is an important part of the care of people taking antiretroviral therapy. This includes asking about the patient’s use of over-the-counter and complementary medicines

Ageing well with human immunodeficiency virus

“…23 Appendix 1 summarises some of the key classes of ART and special considerations. 20,24,25 Patients on complicated and inherently high-risk ART combinations should be regularly reviewed to ensure that they have access to optimal ART regimens; what was historically best practice is no longer the standard of care today.…”

“…When potential issues are identified, healthcare providers should explore barriers to adherence without judgement, providing appropriate support where required. 25,26 Healthcare professionals can support adherence by: 4,21,25,26 • encouraging the use of adherence tools: phone reminders, free apps (e.g. MyLife+ 27 ), dose administration aids • providing information and support resources • providing strategies when cost is a barrier • appropriately counselling on the benefits of ART and strategies for managing negative associations perceived by the patient • ensuring there is a private place to consult • ensuring all staff (including non-clinical) understand HIV transmission risk and treat all people with respect • not conflating HIV with sexuality: this can exacerbate all forms of stigma.…”

“…A well-informed multidisciplinary healthcare team can provide the interventions necessary to ensure PLHIV age with dignity and optimum health. 20,24,25 Nucleoside reverse transcriptase inhibitors (NRTIs): abacavir (ABC), emtricitabine (FTC), lamivudine (3TC), tenofovir disoproxil fumarate or equivalent salt (TDF), tenofovir alafenamide (TAF), and zidovudine (AZT)…”

“…poor tolerability, lack of supporting data, lower virological efficacy, increased interaction potential and toxicities) compared to the above combinations 23 . Appendix summarises some of the key classes of ART and special considerations 20,24,25 . Patients on complicated and inherently high‐risk ART combinations should be regularly reviewed to ensure that they have access to optimal ART regimens; what was historically best practice is no longer the standard of care today.…”

New drug: Cabotegravir for HIV

“…Adherence to therapy is vital for viral suppression in people living with HIV. 1 Therapy is lifelong so there is a need for regimens that are easy to adhere to and well tolerated. Early regimens had a high pill burden and current combination regimens still require daily doses.…”