Switching antiretroviral regimes for the treatment of HIV: safety implications

Abstract

Switching cART has been a popular strategy to address safety issues throughout the antiretroviral era. The myriad of switching studies have paralleled the study and release into clinical practice of new antiretroviral drugs with different and often improved safety profiles. Most of them have been successful in improving antiretroviral toxicity while keeping HIV replication under control. However, it should be taken into account that, whenever a new drug is given, there is a possibility of new drug-related toxicity. Notwithstanding that, an increase in cART switching is foreseen, given the fact that we have a wide antiretroviral drug armamentarium and that people living with HIV are ageing and thus more prone to developing age-related co-morbidities whose therapies may entail new interactions and eventually new toxicities.

Pharmacokinetic testing of a first-generation cabotegravir prodrug in rhesus macaques

“…Control of human immunodeficiency virus (HIV-1) infection requires lifelong combination antiretroviral therapy [1,2] . Adherence to any treatment regimen is a common limitation with consequent emergence of viral mutations and comorbid events [3][4][5][6][7] . The development of long acting parenteral antiretroviral drugs presents an important means to improve regimen adherence with secondary benefits in viral prevention.…”

Reasons for switching ART: Comparison of data collected in 2012–2013 and 2014–2015 in Florence, Italy

“…More recently, switches in ART are becoming an expanding strategy in clinical practice among virologically suppressed patients without side effects, with the aim to reduce drug-drug interactions, prevent long-term toxicity, simplify therapy, and improve adherence. 2…”