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©2013 UpToDate ® Print Email Antiretroviral agents, class adversereactions - II Reaction Fat redistribution Hyperlipidemia Rash Frequency 4 to 50 percent NNRTI: 8 to 16 percent Agents Fat accumulation: PIs Lipoatrophy: NRTIs d4T>ddI>AZT. Also occurs without antiretrovirals. PI NNRTI - NVP >EFV and DLV PIs - increased risk with sulfonamide allergy NRTI - ABC* Risk No clear risks defined Risk for DVC - HBP, diet, obesity, genes, prior MI/stroke, diabetes, age NNRTI - 1st 12 wks Female Sx Fat accumulation - abd (visceral), buffalo hump, breasts, lipomas Fat atrophy - extremities buttocks, face Cardiovascular disease with stroke or MI Common - red rash Severe - Stevens-Johnson synd, TEN, DRESS (Drug Rash, Eosinophilia, and Systemic Systems)* Lab CT scan, MRI, Waist: Hip, Bioelectric Impedence, DEXA, Ultrasound ↑ triglycerides ↑ cholesterol, and LDL cholesterol Eosinophilia - variable Treatment Plastic surgery (but expensive) Exercise? Change PI to NNRTI? Lipoatrophy- d/c d4T, ddI or AZT NECP guidelines: - General: diet and exercise - LDL cholesterol ↑: Pravastatin or atorvastatin - Triglycerides ↑: Gemfibrozil or fenofibrate Most rashes do not require drug discontinuation Withdraw NNRTI if severe; may tolerate other NNRTI (NVP → EFV) Monitor Appearance Fasting lipid profile at baseline, at 3 to 6 months post HAART initiation, then yearly. More frequently if high risk or treated. * DRESS: Life threatening complication that is seen with NVP and ABC - usually in the first 6 weeks of therapy. Reproduced with permission from: Bartlett, JG. Pocket Guide; Adult HIV/AIDS Treatment, November 2003.