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Table 13. Antiretroviral Therapy-Associated Common and/or Severe Adverse Effects

(See Appendix B for additional information listed by drug.) (Page 4 of 4)

Adverse Effects NRTIs NNRTIs PIs INSTI EI

Lipodystrophy Lipoatrophy: Thymidine analogs (d4T > ZDV). May be Lipohypertophy: Trunk fat increase observed with EFV-, PI-, and RAL-containing
more likely when combined with EFV than with a regimens; however, causal relationship has not been established.
ritonavir-boosted PI.

Myopathy/elevated creatine ZDV: myopathy RAL: ↑ CPK. muscle
phosphokinase (CPK) weakness and
rhabdomyolysis

Nephrotoxicity/ TDF: ↑ serum creatinine, proteinuria, IDV: ↑ serum creatinine, pyuria;
urolithiasis hypophosphatemia, urinary phosphate wasting, hydronephrosis or renal atrophy
glycosuria, hypokalemia, non-anion gap metabolic
IDV, ATV: Stone, crystal formation;
acidosis
adequate hydration may reduce risk.
Concurrent use of PI may increase risk.

Osteopenia/ TDF: Associated with greater loss of BMD than ZDV, Decreases in BMD observed in studies of regimens
osteoporosis d4T, and ABC. containing different NRTIs combined with either NNRTIs or
PIs.

Peripheral neuropathy Peripheral neuropathy (pain and/or paresthesias, lower
extremities > upper extremities): d4T > ddI and ddC
(can be irreversible)

Rash All NNRTIs ATV, DRV, FPV RAL: Uncommon MVC

Stevens-Johnson syndrome ddI, ZDV: Reported cases NVP > DLV, EFV, FPV, DRV, IDV, LPV/r, ATV: Reported RAL
(SJS)/ toxic epidermal ETR, RPV cases
necrosis (TEN)

Key to Abbreviations: 3TC = lamivudine, ABC = abacavir, ALT = alanine aminotransferase, ARV = antiretroviral, AST = aspartate aminotransferase, ATV = atazanavir, ATV/r = atazanavir + ritonavir, BMD = bone mineral
density, CNS = central nervous system, CPK = creatine phosphokinase, CVD = cardiovascular disease, d4T = stavudine, ddC = zalcitabine, ddI = didanosine, DLV = delaviridine, DM = diabetes mellitus,
DRV = darunavir, DRV/r = darunavir + ritonavir, ECG = electrocardiogram, EFV = efavirenz, EI = entry inhibitor, ETR = etravirine, FPV = fosamprenavir, FPV/r = fosamprenavir + ritonavir, FTC = emtricitabine,
GI = gastrointestinal, HBV = hepatitis B virus, HDL = high-density lipoprotein, HSR = hypersensitivity reaction, IDV = indinavir, INSTI = integrase strand transfer inhibitor, LDL = low-density lipoprotein,
LPV/r = lopinavir + ritonavir, MI = myocardial infarction, MVC = maraviroc, NFV = nelfinavir, NNRTI = non-nucleoside reverse transcriptase inhibitor, NRTI = nucleoside reverse transcriptase inhibitor,
NVP = nevirapine, PI = protease inhibitor, PT = prothrombin time, RAL = raltegravir, RPV = rilpivirine, RTV = ritonavir, SJS = Stevens-Johnson syndrome, SQV = saquinavir, SQV/r = saquinavir + ritonavir,
TDF = tenofovir, TEN = toxic epidermal necrosis, TG = triglyceride, TPV = tipranavir, TPV/r = tipranavir + ritonavir, ZDV = zidovudine

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