9,10 However,

adverse toxicity of the ARV drugs has been reported to also impart negatively on adherence to treatment.9–11 It is, therefore, necessary that clinicians have a clear understanding of the potential adverse effects of the ARV drugs. In addition, they should be able to readily recognise adverse effects in patients and manage them effectively. The risk of specific adverse effects varies from one ARV drug to another, from one drug class to another, and from one patient to another.12 The spectrum of adverse effects associated with ARVs may also vary between progestogen antagonist developed and developing countries.13 The nucleoside reverse transcriptase inhibitors (NRTIs) are associated with lactic acidosis, lipodystrophy, and hyperlipidemia9,11, while the non-nucleoside reverse transcriptase inhibitors (NNRTIs) are associated with neuropsychiatric symptoms, rash, liver toxicity, and lipid abnormalities.11 Protease inhibitors (PIs) are associated with gastrointestinal intolerance and glucose and lipid abnormalities9.

The entry inhibitor (maraviroc) and the integrase inhibitor (raltegravir) are new drugs used for treatment-naive and treatment-experienced patients. Maraviroc is associated with bronchitis, nasopharyngitis, and esophageal candidiasis, while raltegravir is associated with increased risk of myopathy and rhabdomyolysis.14 selleck chemicals There have been reports of adverse events to specific ARV drugs which include peripheral neuropathy and lipodystrophy associated with stavudine10, 15, anaemia associated with zidovudine16, 17, and nevirapine based hepatotoxicity and rash9, 18–20. The incidence of hepatotoxicity has been reported as 8% and 16% for patients on efavirenz (EFV) and nevirapine (NVP), respectively20, while the incidence of anaemia

associated with zidovudine ranged from 3– 12% in developing countries.13 As a means of improving adherence to ARV drugs, newer ones are available as fixed- dose combination21. Despite the decreased pill counts and frequency of dosing per day for usual starting regimens, ART continue to have significant adverse effects that others require monitoring for drug interactions and long-term morbidity related to cardiovascular, dermatological, bone, musculoskeletal and kidney disease.22 Most clinical trials have a relatively short follow-up duration and can underestimate longer term complications of therapy. A six years follow-up of patients in a Swiss Cohort study showed the presence of laboratory adverse events that was associated with higher rates of mortality, highlighting the importance of adverse events in overall patient management.23 Several factors may predispose individuals to adverse effects of ARV drugs. Females appear to have a higher risk than male to develop Stevens-Johnson syndrome, rashes, and hepatotoxicity from NVP.24,25 Females are also at higher risk than males to develop lactic acidosis from NRTIs.