Side Effects of HIV and AIDS Drugs

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

Doravirine (Pifeltro; also included in Delstrigo)

Skin rash, weight gain

 

efavirenz (Sustiva; also included in Atripla)

 

 

etravirine (Intelence)

Vivid dreamsanxiety, depression, insomnia, skin rash, liver damage, suicidal ideation

 

Skin rash
Should not be used in persons with depression or other psychological abnormalities

nevirapine (Viramune)

 

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

Continued

 

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

 

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.

Continued

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

Continued

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
WebMD Medical Reference Reviewed by Jonathan E. Kaplan, MD on August 02, 2020

Sources

SOURCES:

News release, FDA.

U.S. Dept. of Health and Human Services: "Side Effects of Anti-HIV Medications." 

U.S. Dept. of Health and Human Services: "Enfuvirtide."

New Mexico AIDS Education and Training Center: "Taking Current Antiretroviral Drugs."

U.S. Dept. of Veterans Affairs: "Side Effects Guide."

MedlinePlus: "Drugs, Supplements, and Herbal Information."

WebMD Health News: "Egrifta Approved for HIV-Related Lipodystrophy."

Gilead web site.

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