II. Indications
- Backbone of Anti-Retroviral Therapy (nearly all regimens make use of nRTI agents)
III. Mechanism
- Incorporate into DNA of virus
- Stops building process
- Resulting DNA incomplete, cannot create new virus
IV. Preparations: Most commonly used nRTI agents
- Emtricitabine (FTC)
- Lamivudine (Epivir, 3TC)
- Tenofovir (Viread, TDF or TAF)
- Zidovudine (Retrovir, ZDV or AZT)
V. Preparations: Other nRTI agents
- Abacavir (Ziagen, ABC)
- Didanosine (Videx, ddI)
- Stavudine (Zerit, d4T)
- Zalcitabine (Hivid, ddC)
VI. Preparations: Combination Nucleotide-Nucleoside Reverse Transcriptase Inhibitor (nRTI)
- Atripla: Efavirenz (EFV), Emtricitabine (FTC) and Tenofovir (TDF)
- Combivir: Lamivudine (3TC) and Zidovudine (ZDV)
- Epzicom: Abacavir (ABC) and Lamivudine (3TC)
- Trizivir: Abacavir (ABC), Lamivudine (3TC), and Zidovudine (ZDV)
- Truvada (or Descovy): Emtricitabine (FTC) and Tenofovir (TDF or TAF)
VII. Combinations: nRTI agents commonly used together
-
Stavudine (d4T) and Didanosine (ddI)
- Consider with Hydroxyurea 500 bid
- Stavudine (d4T) and Lamivudine (3TC)
- Zidovudine (AZT) and Didanosine (ddI)
- Zidovudine (AZT) and Zalcitabine (ddC)
- Zidovudine (AZT) and Lamivudine (3TC)
VIII. Adverse Effects: Most common
-
Lactic Acidosis (uncommon, but life-threatening)
- My present with Fatigue, GI distress, abnormal Liver Function Tests, elevated Lipase
- Stop nRTI immediately if Lactic Acidosis >45 mg/dl occurs (switch to nonthymidine nRTI)
-
Lipodystrophy
- See Lipodystrophy
- Associated with prolonged nRTI use and more common with Protease Inhibitors
IX. Adverse Effects: Miscellaneous
- See individual agents regarding specific adverse effects
-
Neuropathy (occurs with 3 D's: DDI, DDC, D4T)
- Didanosine (ddI)
- Zalcitabine (ddC)
- Stavudine (d4T)
-
Pancreatitis (occurs with 3 D's: DDI, DDC, D4T)
- Didanosine (ddI)
- Zalcitabine (ddC)
- Stavudine (d4T)
- Hepatomegaly and Steatosis
- Severe lethal Hypersensitivity Reaction
- Abacavir (occurs on rechallenge after reaction)
- Gastrointestinal upset or Diarrhea