Volume 2 - Issue 1, January - February 2026

Antiretroviral therapy (ART) has transformed HIV infection from a fatal disease into a manageable chronic condition, markedly improving patient survival and quality of life. However, this success is tempered by a wide array of toxic effects associated with antiretroviral drugs (ARVs), which can affect multiple organ systems and pose significant challenges to long-term treatment adherence and outcomes. This comprehensive review synthesizes the latest evidence on the toxicological profiles, underlying mechanisms, and clinical implications of major ARV classes, including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase strand transfer inhibitors (INSTIs), and entry/fusion inhibitors. Key toxicities discussed include mitochondrial dysfunction and lactic acidosis from NRTIs, hepatotoxicity and neuropsychiatric effects from NNRTIs and PIs, renal and bone disorders linked to tenofovir-based regimens, and emerging concerns such as weight gain and cardiovascular risks with INSTIs. The review elucidates dose-dependent, idiosyncratic, and cumulative mechanisms driving these adverse events, drawing from clinical trials, cohort studies, and pharmacovigilance data. Strategies for mitigation, including routine monitoring protocols, therapeutic drug monitoring, and personalized ART regimens guided by pharmacogenomics, are critically evaluated to minimize long-term toxicities while preserving virologic suppression. This synthesis underscores the need for ongoing research into safer ARV formulations and highlights the pivotal role of multidisciplinary care in optimizing HIV management.

John Chimerenka Ifenkwe, Gospel Ajuru, Uzochukwu Alozie Ononuju,"Antiretroviral Therapy in HIV Management: A Synthesis of Organ-Specific Toxicities, Underlying Pathways and Interventions" International Journal of Advanced Multidisciplinary Research and Educational Development, V2(1): Page(946-962) Jan-Feb 2026. ISSN: 3107-6513. www.ijamred.com. Published by Scientific and Academic Research Publishing.