Journal of Antivirals & Antiretrovirals
Open Access

Abstract

A Tolerability Review of Non-Nucleoside Reverse Transcriptase Inhibitors: Focus on Laboratory Measures of Clinical Relevance

Jeffrey T Kirchner

Background: Current antiretroviral (ARV) therapies have greatly extended the life expectancy for many living with HIV infection. Given that ARV therapies must be taken chronically, long-term tolerability associated with these agents is of great importance. Clinical trials and experience have helped clarify short and long-term adverse event data. Among non-nucleoside reverse transcriptase inhibitors (NNRTIs), common laboratory markers of toxicity and tolerability include transaminase elevations and lipid alterations. Some of these issues appear to be a class-specific effect, whereas others appear to be more agent-specific. Selection of the appropriate NNRTI to use while limiting drug-related side effects is an important clinical objective.
Objective: To review clinically relevant data regarding long-term tolerability of NNRTIs.
Methods: A PubMed search was performed using the following keywords: NNRTI, non-nucleoside reverse transcriptase inhibitor, efavirenz, nevirapine, etravirine, rilpivirine and safety, tolerability or clinical. Papers published before 2007 were excluded; papers were included if they reported clinically relevant tolerability outcomes, enrolled more than 50 patients and were conducted for ≥ 48 weeks in HIV-infected patients. Results: Newer agents and formulations have significantly improved the tolerability issues associated with older ARVs and earlier treatment approaches.
Conclusions: Tolerability profile remains to be a distinguishing feature among the agents in this class, and is a key consideration when considering a first-line NNRTI-containing regimen that is individualized to the patient and can achieve long-term virologic suppression. This information may help guide treatment choices in clinical practice.