title: Antiretroviral therapy-associated toxicities in the resource-poor world: the challenge of a limited formulary.
abstract: Toxicities related to antiretroviral therapy make long-term adherence to therapy difficult for patients and present challenges to providers, especially those in the resource-poor world who work with a limited formulary. In resource-poor settings, where limited drug options are the rule, when and how to change therapy are especially difficult problems. Drugs such as stavudine and didanosine are associated with serious metabolic complications, such as lactic acidosis, pancreatitis, and peripheral neuropathy. Antiretroviral agents associated with fewer metabolic effects, such as tenofovir and abacavir, remain widely unavailable. Because the current formulary restrictions appear to be unlikely to change quickly, providers in resource-poor countries must be familiar with the common adverse events-including metabolic complications, hypersensitivity reactions, anemia, and liver enzyme abnormalities-and must understand how to manage them with what is locally available. Most importantly, to avoid drug toxicities, a larger formulary is needed in resource-poor settings, and this must be a high priority for policy makers and health care professionals involved in treating human immunodeficiency virus infection globally.
authors.affiliation: Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. murphy6@partners.org
authors.forename: Richard A
authors.initials: RA
authors.lastname: Murphy
authors.forename: Henry
authors.initials: H
authors.lastname: Sunpath
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kuritzkes
authors.forename: Francois
authors.initials: F
authors.lastname: Venter
authors.forename: Rajesh T
authors.initials: RT
authors.lastname: Gandhi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics / Q000821:virology; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000191:economics; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000191:economics; D003906:Developing Countries; D006801:Humans
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents