Antiretroviral Therapy — Drug Classes & Side Effects
Each antiretroviral class carries a signature side-effect profile that determines what you monitor — confuse them and you'll miss the lab trend that signals organ damage.
Core Concept
NRTIs (zidovudine, tenofovir, lamivudine) carry a class-wide risk of lactic acidosis from mitochondrial toxicity; watch for unexplained tachypnea, fatigue, and rising lactate. Zidovudine specifically causes bone marrow suppression — monitor CBC for anemia and neutropenia. Tenofovir is nephrotoxic and decreases bone density; track serum creatinine, BUN, and phosphorus. NNRTIs (efavirenz, nevirapine) cause vivid CNS effects (dizziness, vivid dreams, mood changes) — advise taking efavirenz at bedtime. Nevirapine carries a hepatotoxicity risk requiring LFT monitoring, especially in the first 18 weeks. Protease inhibitors (atazanavir, lopinavir/ritonavir) produce metabolic syndrome: hyperglycemia, hyperlipidemia, lipodystrophy (fat redistribution), and GI distress. Monitor fasting glucose and lipid panels. Atazanavir causes indirect hyperbilirubinemia with visible jaundice that is benign but alarming to clients — teach them it is expected. Integrase inhibitors (raltegravir, dolutegravir) are generally well tolerated; raltegravir can elevate creatine kinase — report unexplained muscle pain. Dolutegravir may raise serum creatinine by inhibiting tubular secretion, not from true kidney damage. Across all classes, teach adherence: missing doses promotes resistance, which is irreversible.
Watch Out For
Don't confuse NRTI lactic acidosis (metabolic, rising lactate, tachypnea) with a simple GI complaint — it can be fatal. Students mix up tenofovir nephrotoxicity with amphotericin B nephrotoxicity; both damage kidneys but belong to entirely different drug classes. Lipodystrophy is a protease inhibitor hallmark, not an NRTI effect — the fat redistribution pattern (buffalo hump, truncal obesity, facial wasting) points to PIs specifically.
Clinical Pearl
Match the class to its organ target: NRTIs hit mitochondria (marrow, kidneys), NNRTIs hit the brain and liver, PIs hit metabolism (glucose, lipids, fat). Class → organ → lab.
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