Nucleoside and nucleotide analogue reverse transcriptase inhibitor toxicity: how much longer must we wield the sword?

Abstract

Antiretroviral treatment regimens prescribed for HIV infection almost always include nucleoside and/or nucleotide analogue reverse transcriptase inhibitors (NRTIs). Despite extensive clinical experience with NRTI-associated toxicities, there are considerable gaps in our understanding of pathogenesis, risk factors and optimal management. Genomic research is beginning to provide new insights into NRTI toxicity, but more investigation is needed in this area. Improved understanding of the pathogenic and genomic basis of NRTI toxicities, translation of current knowledge into clinical care, more widespread access to less toxic NRTIs, clinical vigilance, and proven and affordable interventions are all required to minimize the worldwide burden of toxicity caused by these important drugs.