HIV medications help HIV-infected persons lead longer, healthier lives. However, AIDS and HIV drug side effects are also common. These side effects range from mild to life threatening. Here is an overview of some of the common and more severe HIV drug side effects.
Common Side Effects of HIV Drugs
The following chart lists some HIV medication side effects that are more common and a few special precautions. To prevent interactions with other medicines, it is important to tell your doctor about all drugs you take. Also tell your doctor right away if you have new, unusual, or long-lasting symptoms.
| Nucleoside Reverse Transcriptase Inhibitors (NRTIs) | Common Side Effects | Special Precautions |
| abacavir (Ziagen; also included in Epzicom, Trizivir, Triumeq) | Hypersensitivity reaction, increase in cholesterol, possible risk of heart disease | Have genetic testing done prior to therapy. |
| didanosine or ddl (Videx, or Videx-EC) | Nausea, vomitingabdominal pain, peripheral neuropathy, , pancreatitis, lactic acidosis, fat loss in arms, legs, or face | Should rarely be used. |
| emtricitabine (Emtriva; also included in Descovy, Truvada, Atripla, Stribild, Genvoya, Complera, Odefsey, Symtuza, Biktarvy) | Rash and skin darkening of palms or soles | |
| lamivudine (Epivir; also included in Combivir, Trizivir, Epzicom, Triumeq, Cimduo, Delstrigo, Dovato) | Skin rash | |
| stavudine, d4T (Zerit, Zerit XR) | Peripheral neuropathy, lactic acidosis,fat loss in arms, legs, or face | Should not be used. |
tenofovir disiproxil fumarate, also known as TDF (Viread; also included in Truvada, Atripla, Stribild, Cimduo, Complera, Delstrigo) tenofovir alafenamide, also known as TAF (Vemlidy; also included in Descovy, Genvoya, Odefsey, Symtuza, Biktarvy) | Kidney and bone damage
Increase in cholesterol, weight gain | Do not use if you have kidney disease |
Zidovudine, also known as AZT (Retrovir; also included in Combivir, Trizivir) | Anemia, nausea, vomiting, lactic acidosis, increase in cholesterol, fat loss in arms, legs or face, fatty liver |
| Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) | Common Side Effects | Special Precautions |
| Headache, tiredness, trouble sleeping, nausea | Should not be used in persons with liver or kidney problems, May cause problems with heart rythm. | |
Doravirine (Pifeltro; also included in Delstrigo) | Skin rash, weight gain | |
efavirenz (Sustiva; also included in Atripla)
etravirine (Intelence) | Vivid dreams, anxiety, depression, insomnia, skin rash, liver damage, suicidal ideation Skin rash | Should not be used in persons with depression or other psychological abnormalities |
rilpivirine (Edurant; also included in Complera, Odefsey, Juluca) | Skin rash, liver damage Depression, difficulty sleeping, skin rash, suicidal ideation | Should not be used in persons with liver problems, or in women with CD4 greater than 250 or in men with CD4 greater than 400
Take with food Should not be used in persons with CD4 less than 200 or HIV viral load greater than 100,000 |
| Protease Inhibitors (PIs) | Common Side Effects | Special Precautions |
| amprenavir (Agenerase) | Nausea, vomiting, liver damage, skin rash | Take with food |
| atazanavir (Reyataz; also included in Evotaz) | Nausea, vomiting, diarrhea, jaundice, gall bladder and kidney stones, liver damage, skin rash, increase in cholesterol, changes in heart rhythm | Take with food |
| darunavir (Prezista; also included in Prezcobix, Symtuza) | Nause, vomiting, diarrhea, skin rash, increase in bad cholesterol, liver damage | Take with food |
| lopinavir/ritonavir (Kaletra) | Nausea, vomiting, diarrhea, skin rash, increase in cholesterol, liver damage | Take with food |
| ritonavir (Norvir; also included in low doses to “boost” other PI drugs) | Nausea, vomiting, taste changes | Take with food. Generally does not cause these symptoms when used in low doses to “boost” other PI drugs |
| Fusion Inhibitor (FI) | Common Side Effects | Special Precautions |
| enfuvirtide (Fuzeon) | Redness, itching, swelling, pain, or hard lumps at injection site | Given by injection |
| Entry Inhibitor | Common Side Effects | Special Precautions |
| maraviroc (Selzentry) | Ski rash, hypersensitivity reaction, liver damage | Have testing done to determine if your CD4 cells have the right receptor
|
| Integrase Inhibitors | Common Side Effects | Special Precautions |
Bictegravir (included in Biktarvy) | Skin rash, weight gain |
|
| cabotegravir (Vocabria) | Fever, fatugue, blisters, uscle or joint ache, swelling in eyes, mouth and face | People with a history of hepatitis B or C virus or people who have certain liver function test changes may have an increased risk of developing new or worsening changes |
| cabotegravir and rilpivirine (Cabenuva) | injection site reactions, fever, fatigue, headache, musculoskeletal pain, nausea, sleep disorders, dizziness, rash | |
| dolutegravir (Tivicay; also included in Triumeq, Dovato, Juluca) | Insomnia, depression, skin rash, suicidal ideation, weight gain |
|
elvitegravir (Vitekta; also included in Stribild, Genvoya)
raltegravir (Isentress) | Insomnia, nausea, diarrhea, depression, skin rash, suicidal ideation, increase in cholesterol, weight gain Insomnia, depression, skin rash, hypersensitivity reaction, suicidal ideation, weight gain |
|
| gp120 Attachment Inhibitor | Common Side Effects | Special Precautions |
| fostemsavir (Rukobia) | nausea, diarrhea, stomach pain, headache, skin rash, fatigue | It has not been tested in children |
| Post attachment inhibitor | Common Side Effects | Special Precautions |
| Ibalizumab (Trogarzo) | diarrhea, skin rash, kidney damage | Given by intravenous infusion |
Severe Side Effects of HIV Drugs
Here are examples of more severe HIV drug side effects:
Hypersensitivity reaction (HSR) can occur in genetically-susceptible persons who receive abacavir and can be life-threatening if the drug is not stopped immediately. It can be prevented by testing for this susceptibility before the drug is used. It may occur 1-6 weeks after starting the drug in susceptible persons. HSR has also been reported for some other ARV drugs.
Symptoms of HSR include:
Fever
Rash
Malaise
Headache
Muscle pains
Nausea, vomiting
Abdominal pain
Lactic acidosis leads to high levels of acid in the blood, which can be fatal. It can result from the use of NRTIs.
Symptoms of lactic acidosis include:
- Long-lasting nausea, vomiting, and abdominal pain
- Unusual fatigue
- Shortness of breath
- Rapid breathing
- Enlarged or tender liver
- Cold or blue hands and feet
- Abnormal heart beat
- Weight loss
Treatment of lactic acidosis may include:
- Changing your drug regimen, but only under the guidance of your doctor
- Intravenous fluids, possibly in the hospital
- Vitamin supplements
Hyperglycemia occurs with higher-than-usual levels of blood sugar, called glucose. It is a symptom of diabetes. However, you can have hyperglycemia without having diabetes. Protease inhibitors, growth hormone drugs, and hepatitis C infection can increase the risk of this side effect.
Symptoms of hyperglycemia include:
- Increased urination
- Excessive thirst or hunger
- Unexplained weight loss
Treatment of hyperglycemia includes:
- Stopping protease inhibitors, but only under the guidance of your doctor
- Hypoglycemic drugs (to lower blood sugar) taken by mouth
- Insulin injected under the skin
Hyperlipidemia is an increase of fat in the blood. These fats include cholesterol and triglycerides. This condition can lead to heart disease and pancreatitis, an inflammation of the pancreas. Some protease inhibitors can increase this side effect.
Symptoms of hyperlipidemia do not exist. The only way to know if you have this condition is to have lab tests at least once a year.
Treatment of hyperlipidemia includes taking cholesterol-lowering drugs, such as statins or fibrates.
Lipodystrophy is also called fat redistribution. If you have it, your body produces, uses, and stores fat differently. This side effect is associated with the use of both NRTIs and PIs as well as the HIV virus itself. It is less common with the newer medications.
Symptoms of lipodystrophy include:
- A buildup of fat in the neck or upper shoulders, belly, or breasts
- A loss of fat in the face, arms, legs, or buttocks
Treatment of lipodystrophy may include:
- A change in HIV drugs, but only under the guidance of your doctor
- Egrifta is a drug given daily by injection. Side effects include joint pain, redness and rash at the site of injection, stomach pain, swelling, and muscle pain. The drug may also cause increases in blood sugar.
- Exercise and diet changes
- Glucophage (metformin), a drug to lower high blood sugar and help reduce abdominal fat
- Hormone treatment (such as human growth hormone), injections of fat or synthetic material, or implants
Hepatotoxicity is liver damage. It may result from several classes of HIV drugs, including NRTIs, NNRTIs, and PIs. Liver damage may include inflammation, death of liver cells, or too much fat in the liver.
Symptoms of liver damage include:
- Increased liver enzymes in the blood
- Nausea or vomiting
- Abdominal pain
- Loss of appetite or diarrhea
- Fatigue
- Yellowing of skin and eyes (jaundice)
- Enlarged liver
Treatment of liver damage includes stopping or changing HIV drugs, but only under the guidance of your doctor.
Skin rashes may range from mild to severe, covering at least 30% of the body's skin surface area. Some are life-threatening. All classes of HIV drugs may cause this side effect.
Symptoms of severe rashes include:
- Flat or raised red spots with blisters in the center
- Blisters in the mouth, eyes, genitals, or other moist areas
- Peeling skin that causes painful sores
- Fever
- Headache
Treatment of skin rashes includes:
- A change in medications, but only under the guidance of your doctor
- Antihistamine drugs
- Hospitalization and intravenous fluids and medications for severe skin rashes