4. 9 History of ARV side effects: most are no longer a risk
When effective ART was first introduced in the UK in 1996, the drugs were remarkable.
They were so effective that people with severe and advanced HIV steadily became well again. The result was so astonishing that this was called the Lazarus effect.
Early ART saved lives, but the drugs were not perfect. They involved many pills, difficult schedules and serious and unexpected side effects were soon being reported.
We needed better treatment and more than 35 different approved drugs and ten single-pill fixed dose combinations have now been approved. Dozens of other experimental compounds were sufficiently promising to enter human studies, but were then stopped because of unexpected side effects, No other illness or infection has so many new drugs drugs approved.
This also means that many of the early side effects are no longer a problem with modern ART.
- anaemia
- serious diarrhoea or fatigue
- lactic acidosis
- peripheral neuropathy
- lipoatrophy (facial fat loss)
- lipodystrophy (fat accumulation)
- hair, nail and skin problems
- hypersensitivity to abacavir
- injection site reacitons to T-20 injections
| ARVs approved in US/Europe * plus 10 Fixed Dose Combinations (FDCs)** | |||||
| 1987 | AZT | 1998 | abacavir | 2007 | maraviroc |
| 1991 | ddI | 1999 | amprenavir | raltegravir | |
| 1992 | ddC | 2000 | lopinavir/r | 2009 | etravirine |
| 1994 | d4T | 2001 | tenofovir | 2011 | rilpivirine |
| 1995 | lamivudine | 2003 | enfuvirtide | 2013 | dolutegravir |
| saquinavir | 2004 | atazanavir | 2014 | elvitegravir | |
| 1996 | indinavir | fosamprenavir | 2016 | Descovy (F/TAF) | |
| ritonavir | emtricitabine | 2017 | bictegravir | ||
| nevirapine | 2005 | tipranavir | 2018 | ibalizumab | |
| 1997 | delavirdine | 2006 | Kaletra (meltrex) | 2020 | fostemsavir |
| nelfinavir | Atripla (FDC) | 2021 | Cabanuva | ||
| 1998 | efavirenz | darunavir | 2022 | lenacapavir | |
| * Approval dates are often different between US and Europe. A similar number of investigational compounds in human studies were also stopped during the development process for safety or efficacy reasons.
** FDCs and some dual nukes: Combivir, Trizivir, Truvada, Atripla, Juluca, Delstrigo, Eviplera, Odefsey, Dovato, Stribild, Symtuza Triumeq, Descovy, Biktarvy, Cabenuva. |
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Last updated: 1 January 2023.