Antiretroviral therapy-associated toxicities in the resource-poor world: The challenge of a limited formulary

被引:44
|
作者
Murphy, Richard A.
Sunpath, Henry
Kuritzkes, Daniel R.
Venter, Francois
Gandlhi, Raiesh T.
机构
[1] Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02214 USA
[2] Massachusetts Gen Hosp, Partners AIDS Res Ctr, Boston, MA 02214 USA
[3] Brigham & Womens Hosp, Sect Retroviral Therapeut, Boston, MA 02115 USA
[4] Harvard Univ, Sch Med, Div Aids, Boston, MA USA
[5] Harvard Univ, AIDS Res Ctr, Boston, MA 02115 USA
[6] Univ Witwatersrand, Johannesburg, South Africa
[7] McCord Hosp, Durban, South Africa
来源
关键词
D O I
10.1086/521112
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Toxicities related to antiretroviral therapy make long-term adherence to therapy difficult for patients and present challenges to providers, especially those in the resource-poor world who work with a limited formulary. In resource-poor settings, where limited drug options are the rule, when and how to change therapy are especially difficult problems. Drugs such as stavudine and didanosine are associated with serious metabolic complications, such as lactic acidosis, pancreatitis, and peripheral neuropathy. Antiretroviral agents associated with fewer metabolic effects, such as tenofovir and abacavir, remain widely unavailable. Because the current formulary restrictions appear to be unlikely to change quickly, providers in resource-poor countries must be familiar with the common adverse events-including metabolic complications, hypersensitivity reactions, anemia, and liver enzyme abnormalities-and must understand how to manage them with what is locally available. Most importantly, to avoid drug toxicities, a larger formulary is needed in resource-poor settings, and this must be a high priority for policy makers and health care professionals involved in treating human immunodeficiency virus infection globally.
引用
收藏
页码:S449 / S456
页数:8
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