NRTIs: Types, uses, side effects - Medical News Today

Although there is no permanent cure for HIV, there are ways to treat and manage the condition to improve a person's longevity and quality of life. One way in which doctors treat HIV is using drugs called nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs).

HIV is a virus that attacks the human immune system and kills specific white blood cells that fight infections. These types of cells are commonly known as CD4 cells.

HIV kills these CD4 cells so that they are not able to fight common infections in the body. As HIV progresses, the reduction in CD4 cells can lead to what doctors call opportunistic infections. However, early treatment can help prevent this outcome.

Doctors may use NRTIs as part of the treatment plan for someone with HIV. NRTIs stop HIV from replicating and killing the CD4 cells.

This article provides an overview of treating HIV using NRTIs. It explains how they work and lists the approved drugs currently available as treatment options.

NRTIs are one of the types of antiretroviral drugs that treat HIV. They work by preventing the virus from multiplying in the body. For HIV especially, NRTIs work by blocking reverse transcriptase, the enzyme that HIV needs to replicate itself.

HIV cannot replicate on its own, which means that it needs a cell to multiply. The cells that HIV enters are CD4 cells, which are white blood cells that fight infections.

After HIV enters the CD4 cells, it changes its RNA into DNA using the reverse transcriptase enzyme. When someone with HIV takes NRTI medications, the enzyme cannot correctly transform RNA into DNA, which slows down the progression of HIV.

The Food and Drug Administration (FDA) has approved the following NRTIs:

• abacavir (Ziagen)
• emtricitabine (Emtriva)
• lamivudine (Epivir)
• tenofovir alafenamide (Vemlidy)
• tenofovir disoproxil fumarate (Viread)
• zidovudine (Retrovir)

In most cases, HIV treatment combines two or more NRTIs. The Department of Health and Human Services notes that some common combinations include:

• abacavir plus lamivudine (Epzicom)
• abacavir plus lamivudine plus zidovudine (Trizivir)
• lamivudine plus zidovudine (Combivir)
• tenofovir alafenamide plus emtricitabine (Descovy)
• tenofovir disoproxil fumarate plus emtricitabine or lamivudine (Truvada or Cimduo)

Usually, a doctor will perform a drug-resistance test to determine whether the NRTIs will likely work. They might also consider prescribing other medications if a person is pregnant or has other health conditions alongside HIV.

Most NRTIs come in the form of pills. However, young children who cannot swallow can take liquid forms of the drugs instead.

Healthcare professionals will most likely start a person with HIV on a treatment plan with one or two NRTIs in addition to another antiretroviral drug.

Although it is safe to take NRTIs with or without meals, it is always essential to take them according to a doctor's prescription. A person should avoid skipping any doses, as HIV can spread and build resistance against the NRTIs.

Most drugs, including NRTIs, can have side effects. Although these side effects are often mild, they can be persistent.

A person should consult a doctor if they have any concerns about the side effects they are experiencing. The doctor can discuss with them how to manage the side effects or switch their prescription to another NRTI.

Some common side effects of multiple NRTIs include:

Although it is uncommon, NRTIs may also cause:

• a buildup of lactic acid in the blood
• liver problems
• pancreatitis
• skin changes, such as discoloration

Allergic reactions

Some people may experience severe allergic reactions to abacavir. This response is common among people who have a genetic variant called HLA-B*5701, which doctors can detect through a blood test.

A person should speak with a healthcare professional if they experience the following symptoms while using abacavir :

• fever
• skin irritation or rash
• nausea, vomiting, or diarrhea
• shortness of breath

A 2018 article states that reactions from abacavir are severe and could be fatal. Due to this, a doctor may consider other options.

Some research suggests that abacavir may increase the chances of heart conditions, such as heart attacks, especially among those with cardiovascular risk factors. Although more research is necessary to confirm this, people with known risk factors for heart conditions should discuss this with a doctor before taking abacavir.

Other side effects

Tenofovir disoproxil fumarate may cause kidney disorders and bone density loss.

Tenofovir alafenamide is a standard replacement NRTI for people who have experienced the above side effects using tenofovir disoproxil fumarate. Although it is safer for the bones and kidneys than tenofovir disoproxil fumarate, it may increase body weight.

Zidovudine may cause anemia and lipodystrophy. It can also lower the white blood cell count, raise lipid levels, or cause muscle weakness, in rare cases.

A person should seek immediate medical attention if any of the following symptoms arise when taking NRTIs:

• skin rash
• rapid breathing
• jaundice
• stomach pain
• vomiting
• bloated stomach
• a pins-and-needles sensation in the feet or hands

HIV is a viral infection that a person can treat and manage well if they receive a diagnosis at an early stage. Doctors use antiretroviral drugs to control HIV.

NRTIs are a class of drugs that prevent the virus from making copies of itself and invading the blood. Taking the medications according to the prescription will help control the condition and reduce the risk of a person developing AIDS.

People should seek medical attention immediately if they notice any side effects while taking HIV medications.

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