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Moderators of Adherence & Retention and GHDonline staff

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Impact of metabolic complications on ART adherence

Added on 20 May 2010
Last updated on 14 Jun 2011

Authors: By Anat Rosenthal, PhD; Reviewed by Sophie Beauvais and Peter Ehrenkranz, MD

Following the post of the abstract “Impact of metabolic complications on antiretroviral treatment adherence: clinical and public health implications” by moderator Jean Nachega, members share their experiences addressing patient adherence challenges related to the chronic side effects of Antiretroviral therapy (ART).

Key Points

  • Several studies report complex and potentially bi-directional relationship between ART toxicities and adherence in which greater adherence can increase drug-related toxicity, therefore reducing tolerability and eventually adherence.
  • Strategies to prevent lipodystrophy include replacing stavudine in treatment guidelines with tenofovir + emtricitabine, lamivudine + efavirenz, or lamivudine + nevirapine.
  • In some resource-limited settings, stavudine may still be the only available and affordable option.  However, it should always be used in its lower dosage form (30 mg BID).  Many countries are now switching to first line regimens that favor AZT or TDF instead.  These regimens should be used whenever possible.  (It is not necessary to switch a patient on stavudine who is not showing side effects, but she/he should be followed closely.)
  • Metabolic complications such as fat changes (lipodystrophy) may occur.
  • Operational research aimed at selecting alternatives to first-line ART medication (triomune) with a high tolerability is being conducted in Malawi.
  • Monitoring and evaluation tools should be revised to include the recording of side effects in each refill visit.

Key References

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Download: 12_2_10_Impact_of_metabolic_complications.pdf (40.7 KB)