When patients cannot take pills: antiretroviral drug formulations for managing adult HIV infection.

Providing antiretroviral therapy for the HIV-infected population is a complex and challenging task. Treatment is often complicated by the shifting demographic of HIV-infected patients that now includes a large aging population in which patients often have multiple comorbidities. HIV clinicans are challenged with choosing the optimal combination of antiretrovirals based on potency, tolerability, bioavailability, and ease of administration. The issue of bioavailability is of paramount importance for those patients who can't swallow tablets, are unable to take anything by mouth before a procedure, or who need medication through a nasogastric tube or percutaneous endoscopic gastrostomy tube. A thorough search of several drug databases, a literature search of MEDLINE through Ovid, and a review of full prescribing information for each currently available antiretroviral drug, was performed to obtain insight into the bioavailability of antiretrovirals. Implications for the findings are discussed as they relate to adherence, resistance, alternative methods of administration, and the sometimes conflicting information on bioavailability that exists for various antiretroviral agents.