Nucleoside Reverse Transcriptase Inhibitors (NRTIs): Classifications, Applications, and Adverse Effects

Nucleoside Reverse Transcriptase Inhibitors (NRTIs): Classifications, Applications, and Adverse Effects

HIV, or Human Immunodeficiency Virus, is a virus that attacks the human immune system and kills specific white blood cells known as CD4 cells [1]. To combat this virus, doctors may use drugs called nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) as part of the treatment plan [2].

NRTIs work by blocking the viral reverse transcriptase enzyme, which HIV needs to convert its RNA into DNA—a critical step in viral replication [3][4]. By inhibiting this enzyme, NRTIs prevent HIV from copying itself and spreading in the body, thereby reducing the viral load [2][3][4].

Common FDA-approved NRTIs include lamivudine, tenofovir disoproxil fumarate, emtricitabine, and abacavir [2][4][5]. They are usually used in combination with other antiretroviral drugs to effectively suppress HIV replication [2][4][5].

It is essential to take NRTIs exactly as prescribed to avoid resistance, and side effects vary depending on the specific NRTI agent used [2][4]. Common side effects of NRTIs include gastrointestinal symptoms such as nausea, diarrhea, and abdominal pain, fatigue, and headache [2][4].

However, some NRTIs may have more serious side effects. For example, tenofovir-based drugs may cause renal toxicity, and abacavir may increase the chances of heart conditions, such as heart attacks, especially among those with cardiovascular risk factors [2][4]. Abacavir may also cause a potentially severe allergic reaction, particularly in people with the HLA-B*5701 genetic variant [2].

In addition, although it is uncommon, NRTIs may cause a buildup of lactic acid in the blood, liver problems, pancreatitis, and skin changes such as discoloration [2].

Patients should seek immediate medical attention if they experience skin rash, rapid breathing, jaundice, stomach pain, vomiting, bloated stomach, or a pins-and-needles sensation in the feet or hands while taking NRTIs [2].

It is also important to note that most HIV treatment combines two or more NRTIs [5]. Some common combinations include abacavir plus lamivudine, abacavir plus lamivudine plus zidovudine, lamivudine plus zidovudine, tenofovir alafenamide plus emtricitabine, tenofovir disoproxil fumarate plus emtricitabine or lamivudine, and tenofovir disoproxil fumarate plus lamivudine [5].

In most cases, HIV treatment starts with one or two NRTIs in addition to another antiretroviral drug [5]. Most NRTIs come in the form of pills, but young children who cannot swallow can take liquid forms of the drugs [6].

A doctor will perform a drug-resistance test to determine whether NRTIs will likely work [7]. It is safe to take NRTIs with or without meals, but it is always essential to take them according to a doctor's prescription [8].

In conclusion, FDA-approved NRTIs inhibit HIV replication by targeting reverse transcriptase and commonly cause gastrointestinal symptoms, fatigue, and, less commonly, serious toxicities like lactic acidosis and hypersensitivity reactions [2][3][4][5]. It is crucial to take these medications according to a doctor's prescription to control the condition and reduce the risk of developing AIDS.

References: [1] HIV. (2021). Retrieved from https://www.nhs.uk/conditions/hiv-and-aids/ [2] HIV Drugs. (2021). Retrieved from https://www.aidsmap.com/hiv-drugs [3] Nucleoside Reverse Transcriptase Inhibitors (NRTIs). (2021). Retrieved from https://www.hiv.gov/hiv-basics/overview/about-hiv-disease/treatment/types-of-hiv-medicine/nucleoside-reverse-transcriptase-inhibitors-nrtis [4] HIV Treatment: Antiretroviral Therapy (ART). (2021). Retrieved from https://www.cdc.gov/hiv/basics/livingwithhiv/managing/treatment.html [5] HIV Treatment. (2021). Retrieved from https://www.hiv.ie/hiv-basics/treatment/ [6] Paediatric HIV Treatment. (2021). Retrieved from https://www.aidsmap.com/paediatric-hiv-treatment [7] Drug Resistance Testing. (2021). Retrieved from https://www.hiv.gov/hiv-basics/overview/about-hiv-disease/treatment/drug-resistance-testing [8] Nucleoside Reverse Transcriptase Inhibitors (NRTIs): When and How to Take Them. (2021). Retrieved from https://www.hiv.gov/hiv-basics/livingwithhiv/managing/medicine/nucleoside-reverse-transcriptase-inhibitors-nrtis-when-and-how-to-take-them

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