Aquatic Ecotoxicology of Antiretrovirals: A Review

Antiretrovirals (ARVs) present variable toxicity to aquatic organisms. This study reviewed the literature from the Web of Science, Scopus, and PubMed to evaluate ARV ecotoxicity, focusing on aquatic models. Inclusion criteria were studies using ARVs as test substances with toxicity data on aquatic organisms. Quality assessment followed the CRED method, and environmental risk was evaluated via risk quotients (RQs) using the ERA tool. Efavirenz emerged as the most toxic ARV, with EC50 values of 0.011 mg/L (Chlorococcum infusionum) to 0.034 mg/L (Raphidocelis subcapitata), causing growth inhibition, photosynthesis reduction, and oxidative stress. Tenofovir showed lower toxicity, with EC50 values above 300.0 mg/L (Biomphalaria glabrata) and 111.82 mg/L (Artemia salina). Other ARVs, including Lamivudine and Zidovudine, displayed moderate toxicity (EC50 3.013–5.442 mg/L in microalgae). Main effects observed included oxidative damage, altered enzyme activity (catalase and NADH-cytochrome C oxidoreductase), reduced growth and photosynthesis, and bioaccumulation in aquatic plants like Lemna minor. Efavirenz also showed synergistic toxicity when combined with other ARVs. These findings indicate that ARVs, particularly highly toxic compounds such as Efavirenz, pose significant ecological risks, emphasizing the importance of proper disposal and remediation strategies to protect aquatic ecosystems.