Toxicity & side effects: switching therapy

DEFINITION

• Modification of ART regimen in virologically suppressed patients[3]
  • Reduce or prevent toxicity
    • Newer regimens are associated with fewer serious adverse effects. From 2011 to 2017, Swedish registry found that reporting of side effects decreased from 32% to 15%.[8]
    • PLWH initiating ART in trials report short-term adverse effects infrequently (< 10%).
  • Improve long-term adherence by reducing pill burden and dosing frequency OR eliminating dietary requirements[2]
  • Avoid long-term ART toxicities, especially in setting of co-morbidities, such as cardiovascular, kidney, or metabolic disease
  • Avoid drug interactions
    • For example, in solid organ transplantation, drug-drug interactions occur between protease inhibitors (i.e., DRV) or pharmacokinetic boosters (i.e., cobi) and required immunosuppressive medications (i.e., tacrolimus).[2]
      • Liverpool HIV Drug Interactions website is essential resource for checking HIV drug-drug interactions. Accessed 10/12/22 at https://www.hiv-druginteractions.org/
  • Exercise option of long-acting injectable ART