A Review of Long-Term Toxicity of Antiretroviral Treatment Regimens and Implications for an Aging Population.

Anita Chawla,Corklin Steinhart,Cody Patton,Annemiek De Ruiter,Christina Wang,Miranda Murray,Yogesh Punekar

doi:10.1007/s40121-018-0201-6

Abstract

Human immunodeficiency virus (HIV) is a chronic infectious disease currently requiring lifelong antiretroviral therapy (ART). People living with HIV (PLWH) face an increased risk of comorbidities associated with aging, chronic HIV, and the toxicity arising from long-term ART. A literature review was conducted to identify the most recent evidence documenting toxicities associated with long-term ART, particularly among aging PLWH. In general, PLWH are at a greater risk of developing fractures, osteoporosis, renal and metabolic disorders, central nervous system disorders, cardiovascular disease, and liver disease. There remains limited evidence describing the economic burden of long-term ART. Overall, an aging HIV population treated with long-term ART presents a scenario in which the clinical, humanistic, and economic burden for healthcare systems will demand thoughtful policy solutions that preserve access to treatment. Newer treatment regimens with fewer drugs may mitigate some of the cumulative toxicity burden of long-term ART.Funding: ViiV Healthcare.Electronic supplementary materialThe online version of this article (10.1007/s40121-018-0201-6) contains supplementary material, which is available to authorized users.

Highlights

Antiretroviral therapy (ART) has led to substantial improvements in the life expectancy of patients infected with human immunodeficiency virus (HIV), which is treated as a chronic disease requiring life-long ART treatment [1,2,3]
Current ART regimens are generally well tolerated with fewer associated severe adverse events (AEs) that are life-threatening or that lead to disability or permanent damage in the short term compared with older regimens; AE profiles that have been documented across all classes of ART are reported in Table 1 [4, 5]
The objective of this review is to provide a synthesis of evidence documenting the toxicity implications arising from long-term ART use in high-income settings, as it relates to an aging population of People living with HIV (PLWH)

Summary

Introduction

Antiretroviral therapy (ART) has led to substantial improvements in the life expectancy of patients infected with human immunodeficiency virus (HIV), which is treated as a chronic disease requiring life-long ART treatment [1,2,3]. Class Frequent AEs (‡ 10% of patients) Severe AEs. NRTI Steatosis, peripheral neuropathy, lipoatrophy, dyslipidemia. Systemic hypersensitivity syndrome, rhabdomyolysis, hyperlactatemia, pancreatitis, increased fracture risk, Fanconi syndrome. NNRTI Depression, sleep disturbances, headache, Suicidal ideation, systemic hypersensitivity, rash dyslipidemia, lower plasma 25(OH) vitamin D PI. Nausea and diarrhea, hyperbilirubinemia, Hepatitis, ischemic heart disease, intracranial hemorrhage, nephrolithiasis, increase of abdominal fat, dyslipidemia dyslipidemia. Current ART regimens are generally well tolerated with fewer associated severe adverse events (AEs) that are life-threatening or that lead to disability or permanent damage in the short term compared with older regimens; AE profiles that have been documented across all classes of ART are reported in Table 1 [4, 5].

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Conclusion