Nursing Pharmacology: Antiviral Drugs
Antiviral Drugs
Anti-viral drugs with activity against HIV (Human Immunodeficiency Virus)
HIV-1 Pathophysiology/Pathogenesis: HIV Disease Presentations
Effects of Anti-Retroviral Medications
Liver injury has been associated with some anti-HIV retroviral drugs.2
Even fatal reactions have been described with nucleoside analogues, non-nucleoside analogues and protease inhibitors.
Nucleoside analogues inhibit DNA synthesis which can result in mitochondrial toxicity, thus interfering with normal oxidative metabolism.2
Nucleoside reverse transcriptase inhibitors (NRTIs )-induced mitochondrial toxicity appears important in promoting lipoatrophic element of HIV-associated lipodystrophy syndrome.10
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NRTIs inhibit mitochondrial DNA polymerase-γ (mtDNA-γ), important for mtDNA replication.
mtDNA encodes for many oxidative-phosphorylation chain proteins.
Hepatotoxicity associated with some anti-HIV retroviral drugs or HIV-related agents has been described not only as a common cause of hepatic abnormalities but that toxicity of some drugs may be worsened in the presence of hepatitis C infection.9
Under these circumstances, individuals may exhibit elevated serum alanine transaminase (ALT) or aspartate aminotransferase (AST) serum levels.
With some agents including macrolide antibiotics, such as azithromycin, or trimethoprim-sulfamethoxazole other liver injury patterns may be observed.
Since such liver injury may be asymptomatic, monitoring of serum liver enzymes becomes a prominent means of detection.
Within the HIV antiretroviral class, administration of HIV protease inhibitors such as tipranavir/ratonavir or with non-nucleoside reverse-transcriptase inhibitor such as nevirapine may result in severe hepatotoxicity.9
A clinical study evaluated the frequency of significant hepatotoxicity as described by grade 3 or grade 4 changes in alanine or aspartate transaminase levels, considering 568 patients receiving non-nucleoside reverse transcriptase inhibitors (NNRTIs) involving nevirapine (NVP) and efavirenz (EFV).11
These agents have been identified is associated with severe hepatic pathologies.11
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