HAART (highly active anti-retroviral therapy)

• A combination of 3 drugs from at least 2 drug classes to which HIV is susceptible

Main indication

• Management of HIV

Mechanism of action

• Antiretrovirals

Contraindications and cautions

• Protease inhibitors are generally potent liver enzyme inhibitors
• Some drugs require pharmacological boosting (with potent liver enzyme inhibitors)
• NNRTIs are generally potent liver enzyme inducers

Adverse effects

• GI side-effects (protease inhibitors)
• Skin: rash, hypersensitivity, Stevens-Johnsons (abacavir, nevirapine)
• CNS side-effects: mood, psychosis (efavirenz, dolutegravir)
• Renal toxicity:  proximal renal tubulopathies, nephrolithiasis (tenofovir disoproxil, atazanavir)
• Bone:  osteomalacia (tenofovir dispoproxil)
• CVS:  increased MI risk (abacavir, lopinavir, maraviroc)
• Haematology:  anaemia (zidovudine)
• GI:  transaminitis, fulminant hepatitis (nevirapine, most others)

Administration