ABSTRACT
Introduction: There are multiple reasons to switch from a virologically successful antiretroviral regimen. Some of them are related to toxicity. Lately, combination antiretroviral treatment (cART) switches have often been related to drug-drug interactions which may also eventually entail safety issues as well.
Areas covered: The purpose of this review is to analyze causes of switching between virologically successful cART regimes related to safety issues. The most relevant papers were selected and summarized.
Expert opinion: Switching cART has been a popular strategy to address safety issues throughout the antiretroviral era. The myriad of switching studies have paralleled the study and release into clinical practice of new antiretroviral drugs with different and often improved safety profiles. Most of them have been successful in improving antiretroviral toxicity while keeping HIV replication under control. However, it should be taken into account that, whenever a new drug is given, there is a possibility of new drug-related toxicity. Notwithstanding that, an increase in cART switching is foreseen, given the fact that we have a wide antiretroviral drug armamentarium and that people living with HIV are ageing and thus more prone to developing age-related co-morbidities whose therapies may entail new interactions and eventually new toxicities.
Article highlights
Antiretroviral drug switching has been a popular strategy to address antiretroviral drug toxicity
Keeping viral replication under control is a sine qua non condition to design a switch from an otherwise virologically successful therapy
The driving force for switching strategies has been the availability of newer drugs with improved safety profiles
The availability of new and better tolerated drugs have modified the spectrum of switching from reactive to proactive
Integrase inhibitors are currently the most used drugs in switching strategies
To avoid or prevent drug-drug interactions is an increasingly cause to switch virologically successful drugs
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Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
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