Noninfectious HIV-related Comorbidities and HAART Toxicities: Choosing Alternative Antiretroviral Strategies

Lidia Gazzola; Camilla Tincati; Antonella d'Arminio Monforte


HIV Ther. 2010;4(5):553-565. 

In This Article

Novel ARV Strategies: NRTI-sparing Regimens

Among drugs included in conventional regimens, the tolerability and toxicity of NRTIs are of major concern for clinicians: some older NRTIs inhibit DNA γ-polymerase and induce mitochondrial dysfunction, resulting in plasma hyperlactatemia and a large spectrum of illness: peripheral neuropathy, myopathies, steatohepatitis, pancreatitis, lipoatrophy and renal tubular acidosis. These adverse events often require NRTI cessation to improve and resolve, while the use of the newer NRTIs may be limited by renal, bone or cardiovascular comorbidities. Thus clinicians may be forced to administer ARV regimens without NRTIs.[55–57]

Starting from this therapeutic challenge, several studies have been designed thus far to explore the immune–virologic efficacy and tolerability of new therapeutic strategies aimed at avoiding NRTI-related toxicities. We have selected and reviewed the main clinical trials on NRTI-sparing regimens as initial therapy or switch strategy, in virologically suppressed patients.


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