What is a potential adverse effect associated with nucleoside reverse transcriptase inhibitors (NRTIs)?

Nucleoside reverse transcriptase inhibitors (NRTIs) are a class of antiretroviral medications primarily used in the treatment of HIV. One well-documented adverse effect associated with NRTIs is lactic acidosis. This condition arises due to mitochondrial toxicity, which is a unique side effect of certain NRTIs.

NRTIs, like stavudine, didanosine, and zidovudine, can interfere with mitochondrial DNA synthesis. This interference can lead to mitochondrial dysfunction and an accumulation of lactic acid in the bloodstream. Patients may present with symptoms such as nausea, vomiting, abdominal pain, fatigue, and rapid breathing, which can escalate to more severe manifestations if not identified and managed promptly.

In contrast to lactic acidosis, hypersensitivity syndrome is more commonly linked to the non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as abacavir, while crystal-induced nephropathy and acute liver failure are not traditionally associated with NRTIs. Crystal-induced nephropathy tends to be more related to medications that cause precipitation of crystals in the renal tubules, and acute liver failure typically arises from other hepatotoxic medications or viral hepatitis rather than NRTIs.