Identification, management, and prevention of adverse effects associated with highly active antiretroviral therapy.

PURPOSE: The adverse effects associated with highly active antiretroviral therapy (HAART), as well as potential options available for management of these complications, are summarized.
SUMMARY: Effective treatment of human immunodeficiency virus (HIV) infection requires three or four drug regimens that are complicated and commonly associated with adverse effects. This makes compliance difficult and can result in treatment failures, development of resistance, and loss of future treatment options. In addition, some adverse effects may lead to an increase in morbidity and represent additional risk factors for future complications. Serious adverse events after the initiation of HAART are related to both patient and treatment characteristics. Most organ systems can be affected, depending on the drug or class of drugs being used; therefore, proper identification of adverse effects can be difficult. The most common adverse effects are gastrointestinal, neurologic, metabolic, and cardiovascular, although renal, dermatological, and hematologic events may also be encountered. Adverse-effect management has included treatment interruptions and therapeutic drug monitoring but most commonly involves switching to another drug or class of drugs. This requires a complete understanding of HAART regimens and their associated complications. HIV clinics that have employed clinical pharmacists have been able to successfully prevent or identify adverse effects through suggestions for effective treatment alternatives, medication counseling, and compliance education.
CONCLUSION: The identification, management, and prevention of adverse events associated with HAART can be difficult but are integral components of effective treatment. Proper interventions are cost-effective and have resulted in improved quality of life for patients infected with HIV.