HIV medications help people with HIV lead longer, healthier lives. They're an essential part of taking care of yourself. But AIDS and HIV drug side effects are also common. These side effects range in severity from mild to life-threatening but can often be prevented or managed.
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, be sure you 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, Triumeq, Trizivir) | Hypersensitivity reaction, increase in cholesterol, possible risk of heart disease | Get genetic testing done before you start on this medication. |
| emtricitabine (Emtriva; also included in Atripla, Biktarvy, Complera, Descovy, Genvoya, Odefsey, Stribild, Symtuza, Truvada) | Rash and skin darkening of palms or soles | |
| lamivudine (Epivir; also included in Cimduo, Combivir, Delstrigo, Dovato, Epzicom, Triumeq, Trizivir ) | Skin rash | |
tenofovir disoproxil fumarate, also known as TDF (Viread; also included in Atripla, Cimduo, Complera, Delstrigo, Stribild, Truvada) tenofovir alafenamide, also known as TAF (Vemlidy; also included in Biktarvy, Descovy, Genvoya, Odefsey, Symtuza) | Kidney and bone damage
Increase in LDL ("bad") cholesterol, weight gain | Don't 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 dreams, anxiety, depression, insomnia, skin rash, liver damage, suicidal ideation
Skin rash | Should not be used in people with depression or other mental illnesses |
nevirapine (Viramune) rilpivirine (Edurant; also included in Complera, Juluca, Odefsey)
rilpivirine for intramuscular injection (combined with cabotegravir as Cabenuva) | Skin rash, liver damage Depression, trouble sleeping, skin rash, suicidal ideation
Injection site reactions (pain, swelling) | Should not be used in people 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 people with CD4 less than 200 or HIV viral load greater than 100,000 |
| Protease Inhibitors (PIs) | Common Side Effects | Special Precautions |
| 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) | Nausea, 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 doesn't 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 | Get 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, fatigue, blisters, muscle 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 be more likely to develop 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 Dovato, Juluca, Triumeq) | Insomnia, depression, skin rash, suicidal ideation, weight gain |
|
elvitegravir (Vitekta; also included in Genvoya, Stribild)
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 | 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 |
| Capsid inhibitor | Common Side Effects | Special Precautions |
| lenacapavir (Sunlenca) | Nausea, redness or pain at the injection site | First given as pills as well as injection |
Short-Term Side Effects of HIV Drugs
When you first start antiretroviral therapy (ART) or if the doctor changes your antiretroviral drugs, you may have side effects as your body adjusts. They usually get better within a few weeks. Often, you can do or take something to prevent or ease the side effects.
If your symptoms don't improve, or if they're severe or unusual, tell your doctor right away. They can figure out if the medication or something else is to blame.
These steps can help you manage some of the most common side effects:
Fatigue. Try brief, 20- to 30-minute naps. Cut back your work schedule if you can. Balanced meals will give your body fuel, and gentle exercise can boost your energy.
Feeling queasy and throwing up. You need to take some HIV medicines with food. Make sure you know which ones they are. If you're not sure, ask your pharmacist. You can also check the drug's label. Another option is to look up your drug on WebMD's Drugs & Medications A-Z index. Avoid eating things that could trigger an upset stomach. Ginger – in ginger ale, ginger tea, or gingersnaps – may help settle your tummy. Eat some crackers in the morning. Stick with small meals and cold foods. Drink a lot of water to stay hydrated. Don't take antacids or other over-the-counter products unless your doctor says it's OK.
Diarrhea. Drink plenty of fluids so you don’t get dehydrated. Talk to your doctor about which over-the-counter (OTC) diarrhea products are safe to take.
Headaches. An OTC pain reliever may work. Rest, drink plenty of fluids, and stay away from loud noise and bright light.
Insomnia. Limit caffeine and avoid heavy meals close to bedtime. It may be tempting, but try not to take daytime naps; stay on a regular sleeping schedule. Try relaxing bedtime habits such as warm baths, warm milk, soothing music, or massage to tell your body it's time to sleep.
Rashes. Avoid long, hot showers or baths, and skin products with alcohol or harsh chemicals. Use sunscreen and moisturizing lotions or petroleum jelly on dry, itchy areas.
Skin reactions to injections. If you have to give yourself shots, check with your doctor to make sure your technique is good. Change the site to give your skin and tissues a chance to heal. Warm the medicine in your hands before you inject it, and apply a cold pack to the area afterward.
Pain, tingling, or numbness in your feet or hands. Gently massage them. Wear loose-fitting shoes or jewelry. Over-the-counter pain relievers like ibuprofen or naproxen may help.
Dry mouth. Suck on sugarless candies or lozenges, or chew sugarless gum. Drink plenty of liquids. Avoid sugary or sticky foods and caffeine.
Remember that all of these can also be signs of a health problem that isn’t related to your HIV treatment. Always call your doctor if you’re thinking about stopping a medication because of side effects. If you have serious symptoms, whether they’re linked to your medicines or not, call the doctor. If they’re very serious, call 911.
Long-Term Side Effects of HIV Drugs
Some side effects may not go away or could cause serious problems. But there’s often a way to manage them.
Fat redistribution. Your body may change the way it makes, uses, and stores fat. Doctors call this lipodystrophy. You might lose fat in your face and legs while gaining it in your belly and the back of your neck. Switching medications can keep symptoms from getting worse, and there are few other options for dealing with this.
Higher cholesterol or triglyceride levels. These can raise your risk for problems like heart disease. Diet and other lifestyle changes are a first step. The doctor may also want you to take medications such as statins or fibrates.
High blood sugar. Regular exercise, maintaining a healthy weight, and other lifestyle changes are a good place to start. Your doctor may also prescribe medicine to help control your blood sugar.
Liver damage (hepatotoxicity). This is more likely if you have hepatitis B or hepatitis C, drink alcohol, take other drugs that can hurt your liver, or already have liver problems. Symptoms include rash, stomach pain, fatigue, jaundice, loss of appetite, dark urine, and light-colored bowel movements. Your doctor will watch you for liver damage once you start HIV treatment, and they might change your medications if you show symptoms.
Bone density loss. You could be more likely to get broken bones, especially as you get older. Try weight-bearing exercises like walking or weightlifting. Check with your doctor about taking calcium and vitamin D supplements. You may need medications to treat or prevent osteoporosis.
Weight gain. This has been linked to the newer class of HIV drugs (integrase inhibitors), but the relationship is unclear. This is the preferred class of HIV drugs, so what to do about weight gain in this setting is unclear. Talk with your doctor about your options.
Mitochondria problems (mitochondrial toxicity). Mitochondria are the parts of cells that are key to how they make energy. HIV medicines called nucleoside reverse transcriptase inhibitors (NRTIs) can affect how mitochondria work, causing problems throughout your body, including with your heart, pancreas, muscles, or nerves. If you show signs of these conditions, your doctor will probably change your medications.
A buildup of a cellular waste product (lactic acidosis). It's uncommon, but it can cause a wide range of problems, from muscle aches to liver failure. Mitochondria damage could be behind it. You may need to switch medicines.
Severe Side Effects of HIV Drugs
Here are examples of more severe HIV drug side effects:
Hypersensitivity reaction (HSR) can happen in people who take abacavir and whose genes make them more likely to have HSR. It can be life-threatening if the drug is not stopped right away. It can be prevented by testing for this tendency before the drug is used. It may occur 1-6 weeks after starting the drug. HSR has also been reported for some other ARV drugs.
Symptoms of HSR include:
- Fever
- Rash
- Malaise
- Headache
- Muscle pains
- Nausea, vomiting
- Belly 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 belly 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 plan, but only under the guidance of your doctor
- IV 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. But 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 don't 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 HIV 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
- Tesamorelin (Egrifta) is a drug given daily as a shot. Side effects include joint pain, redness and a rash at the injection site, 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
- Belly pain
- Loss of appetite or diarrhea
- Fatigue
- Yellowing of the 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 IV fluids and medications for severe skin rashes
