Antiretroviral regimens sparing agents from the nucleoside(tide) reverse transcriptase inhibitor class: A review of the recent literature

27Citations
Citations of this article
57Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

The nucleoside(tide) reverse transcriptase inhibitors (NRTIs) have traditionally been an important 'back-bone' of an antiretroviral therapy (ART) regimen. However all agents have been associated with both short- and long-term toxicity. There have also been concerns regarding the efficacy and safety of a treatment sequencing strategy in which those with past exposure and/or resistance to one or more NRTIs are re-exposed to 'recycled' NRTIs in subsequent ART regimens. Newer, potent and possible safer, agents from various ART classes continue to become available. There has therefore been growing interest in evaluating NRTI-sparing regimens. In this review, we examined studies of NRTI-sparing regimens in adult HIV-positive patients with varying degrees of ART experience. We found that in treatment experienced patients currently on a failing regimen with detectable viral load, there now exists a robust evidence for the use of NRTI-sparing regimens including raltegravir with a boosted-protease inhibitor with or without a third agent. In those on a virologically suppressive regimen switching to a NRTI-sparing regimen or in those ART-naïve patients initiating an NRTI-sparing regimen, evidence is sparse and largely comes from small exploratory trials or observational studies. Overall, these studies suggest that caution needs to be exercised in carefully selecting the right candidate and agents, especially in the context of a dual-therapy regimen, to minimise the risks of virological failure. There is residual toxicity conferred by the ritonavir boost in protease-inhibitor containing NRTI-sparing regimens. Fully-powered studies are needed to explore the place of N (t)RTI-sparing regimens in the sequencing of ART. Additionally research is required to explore how to minimise the adverse effects associated with ritonavir-based pharmacoenhancement. © 2013 Achhra and Boyd; licensee BioMed Central Ltd.

References Powered by Scopus

HLA-B*5701 screening for hypersensitivity to abacavir

1620Citations
N/AReaders
Get full text

Antiretroviral treatment of adult HIV infection: 2012 Recommendations of the International Antiviral Society-USA panel

748Citations
N/AReaders
Get full text

Class-sparing regimens for initial treatment of HIV-1 infection

632Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Efficacy and safety of contemporary dual-drug antiretroviral regimens as first-line treatment or as a simplification strategy: a systematic review and meta-analysis

53Citations
N/AReaders
Get full text

Once-daily maraviroc versus tenofovir/emtricitabine each combined with darunavir/ritonavir for initial HIV-1 treatment

44Citations
N/AReaders
Get full text

Chronic Kidney Disease and Antiretroviral Therapy in HIV-Positive Individuals: Recent Developments

40Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Achhra, A. C., & Boyd, M. A. (2013, December 13). Antiretroviral regimens sparing agents from the nucleoside(tide) reverse transcriptase inhibitor class: A review of the recent literature. AIDS Research and Therapy. https://doi.org/10.1186/1742-6405-10-33

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 24

65%

Researcher 11

30%

Professor / Associate Prof. 2

5%

Readers' Discipline

Tooltip

Medicine and Dentistry 30

79%

Nursing and Health Professions 3

8%

Agricultural and Biological Sciences 3

8%

Psychology 2

5%

Save time finding and organizing research with Mendeley

Sign up for free