All ARV drugs have class-specific adverse effects.
° NsRTIs: fatty changes in the liver lactic acidosis lipodystrophy syndrome with prolonged use
° PIs: lipodystrophy syndrome elevated serum cholesterol and triglycerides elevated blood glucose bleeding episodes in patients with haemophilia
° NNRTIs: skin rash abnormal liver enzymes/hepatitis
Lactic acidosis is due to toxicity of NsRTIs on cellular mitochondria. If unrecognized, it is potentially fatal. If patients develop pronounced fatigue, nausea, vomiting and abdominal pain, lactic acidosis should be considered.
Lipodystrophy syndrome has distinctive features.There is peripheral fat loss around the face, limbs and buttocks. Fat accumulates centrally around the abdomen and breasts and over the back of the neck (so-called "buffalo hump"). Often associated with lipodystrophy are raised blood levels of cholesterol, triglycerides and glucose.
Other specific drug side-effects include:
NsRTIs zidovudine didanosine zalcitabine stavudine lamivudine abacavir
NNRTIs nevirapine efavirenz delavirdine PIs saquinavir ritonavir indinavir nelfinavir amprenavir lopinavir/ritonavir nausea, headache, fatigue, muscle pains, myopathy, anaemia, agranulocytosis, nausea, diarrhoea, neuropathy, pancreatitis neuropathy, pancreatitis, oral ulcers neuropathy, pancreatitis nausea, headache, fatigue, muscle pains, anaemia, agranulocytosis, nausea, fatigue, sleep disturbance, hypersensitivity reaction rash, hepatitis neuropsychiatric disturbances headaches nausea, diarrhoea nausea, diarrhoea, weakness, skin sensitivity, abnormal taste, perioral numbness nausea, abdominal pain, headache, kidney stones diarrhoea, nausea, skin rash nausea, vomiting, diarrhoea, abnormal taste, mood disorder, perioral numbness abdominal pain, diarrhoea, fatigue, headache, nausea, vomiting, pancreatitis
Monitoring the safety of ART and tolerance depends on clinical assessment and laboratory tests. Laboratory tests include measurements of full blood count, liver enzymes, serum amylase (pancreatitis), glucose, triglycerides and creatine phosphokinase (myopathy). Different ART regimens require different laboratory tests.
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