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

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

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

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

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

6. III Nucleotide Analogues (Nucleotide Reverse Transcriptase Inhibitors)
Tenofovir (TDF)

7. IV Protease Inhibitors (PIs)
Lopinavir (LPV)
Ritonavir (RTV)

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

9. 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

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

11. 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

12. 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).

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

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

15. Emtricitabine (FTC) e
Headache
Nausea
Vomiting

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

17. 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.

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

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

20. 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

21. ASANTE!