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credit attribution: The Global Health Delivery Project, GHDonline.org,
May 20, 2010.
for more information.
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).
- 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.
- World Health Organization (WHO): Rapid advice: Antiretroviral therapy for HIV infection in adults and adolescents (November 2009, English, Francais)
- Nachega, J. B et al. 2009. Impact of metabolic complications on antiretroviral treatment adherence: Clinical and public health implications. Current HIV/AIDS Reports. Vol.6(1):121-129 (English, subscription required).
- World Health Organization (WHO): Antiretroviral therapy for HIV infection in adults and adolescents Recommendations for a public health approach (2006 revision): English (PDF), Français (PDF).
- WHO 2006 Addendum: New dosage recommendations for Stavudine (d4T) is now recommended at the dose of 30 mg twice daily for all adult and adolescent patients regardless of body weight: English, (PDF), Français (PDF)
- The Partners In Health Guide to the Community-Based Treatment of HIV in Resource-Poor Settings (Partners In Health, 2008): English (PDF), Français (PDF) – please note: each PDF is 1Mb)
- Side Effects of Antiretroviral Drugs: Related Resources, July 2009; HIV InSite, University of California, San Francisco (English)
Enrich the GHDonline Knowledge Base: Please consider replying to this discussion with the following information
Download: 12_2_10_Impact_of_metabolic_complications.pdf (40.7 KB)