Side effects of antiretroviral drugs

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Presentation transcript:

Side effects of antiretroviral drugs Outi Vehviläinen, MD Ilembula Lutheran Hospital 31.1.2014

My presentation What are the drugs? How are the drugs combinated and coded? The most important side effects Conclusion 27.4.2017

TYPES OF ANTIRETROVIRAL DRUGS Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Nucleotide Reverse Transcriptase Inhibitors (Nucleotide Analogues) Protease Inhibitors (PIs) 27.4.2017

I Nucleoside Reverse Transcriptase Inhibitors (NRTIs ) Zidovudine (AZT) Lamivudine (3TC) Abacavir (ABC) Emtricitabine (FTC) 27.4.2017

II Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Efavirenz (EFV) Nevirapine (NVP) 27.4.2017

III Nucleotide Analogues (Nucleotide Reverse Transcriptase Inhibitors) Tenofovir (TDF) 27.4.2017

IV Protease Inhibitors (PIs) Lopinavir (LPV) Ritonavir (RTV) 27.4.2017

How are the drugs combinated and coded? FIRST LINE Zidovudine (AZT) Lamivudine (3TC) Nevirapine (NVP) 1b Zidovudine (AZT) Lamivudine (3TC) Efavirenz (EFV) 1c Tenofovir (TDF) Emtricitabine (FTC) Efavirenz (EFV) 1e Tenofovir (TDF) Lamivudine (3TC) Efavirenz (EFV) 1g SECOND LINE Abacavir (ABC) Lamivudine (3TC) Lopinavir/Ritonavir (LPV/r) 2g 27.4.2017

The most important side effects First category: Mild and transient symptoms:mild headaches, mild gastric upset, nausea, fatigue and the CNS-disturbances Second category: More severe gastric upset with nausea and vomiting, more severe headaches and mild peripheral neuropathy, mild rash. Third category: Symptoms are severe ARV drugs must be stopped Anaemia, nausea, vomiting, dehydration,severe headache, fatigue 27.4.2017

headache, fatique, malaise nausea, vomiting myalgia, myopathy Zidovudine (AZT) 1b, 1c Anaemia neutropenia headache, fatique, malaise nausea, vomiting myalgia, myopathy 27.4.2017

Nevirapine (NVP) 1b Hepathotoxicity may be life threatening is more common in higher CD4 cell counts, in women and in patients with hepatitis B or C 27.4.2017

Nevirapine (NVP) 1b Hypersensitivity Stevens -Johnson Syndrome Mild Erythema,urticaria No blistering of skin No angioedema No systemic signs Stevens -Johnson Syndrome Severe rash, erytema, urticaria, desquamation, skin blistering, exfoliative dermatitis, erytema multiforme, fissured lips Anaphylaxis Angioedema Systemic signs (body aches, arthalgias, myalgias, fevers lyphadenopathy). 27.4.2017

Efavirenz (EFV)side effects 1c,1e, 1g CNS- side effects: headache,vivid dreams, nightmares, vertigo, confusion, mood changes elevation of liver function tests hyperlipidemia 27.4.2017

acute and chronic renal failure proteinuria, Tenofovir (TDF) 1e 1g Nefrotoxicity acute and chronic renal failure proteinuria, renal insufficiency (histology: focal glomerulosclerosis) 27.4.2017

Emtricitabine (FTC) 1e Headache Nausea Vomiting 27.4.2017

Lamivudine (3TC) 1b,1c, 2g Headache Nausea Vomiting 27.4.2017

Acabavir (ABC) 2g Hypersensitivity flu symptoms, shortness of breath, cough, fever, aches, pains, general ill feeling,fatigue, abdominal pain,diarrhoea, nausea, muscle aches, numbness, sore throat or rash. occurs in up to 5% of patients, can be fatal. 27.4.2017

Lopinavir/Ritonavir (LPV/r) 2g Lopinavir (LPV) diarrhea, nausea, vomiting, dyslipidemia Ritonavir (RTV) diarrhea, vomiting, abdominal pain, elevation of liver function tests, hyperuricemia 27.4.2017

Conclusion I Zidovudine (AZT) Lamivudine (3TC) Nevirapine (NVP) 1b FIRST LINE Zidovudine (AZT) Lamivudine (3TC) Nevirapine (NVP) 1b Zidovudine (AZT) Lamivudine (3TC) Efavirenz (EFV) 1c Tenofovir (TDF) Emtricitabine (FTC) Efavirenz (EFV) 1e Tenofovir (TDF) Lamivudine (3TC) Efavirenz (EFV) 1g SECOND LINE Abacavir (ABC) Lamivudine (3TC) Lopinavir/Ritonavir (LPV/r) 2g 27.4.2017

CONCLUSION II 1 b anaemia, hypersensitivity, hepatotoxicity anaemia, CNS-symptoms renal insufficiency, CNS-symptoms hypersensitivity, headache, vomiting, diarrhea, abdominal pain 1 c 1 e 1 g 2 g 27.4.2017 http://www.eacsociety.org/Guidelines.aspx

ASANTE!