Side Effects of HIV and AIDS Drugs

HIV medications help many people 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, 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
Ziagen (abacavir) Hypersensitivity reaction Have genetic testing done prior to therapy.
Combivir (lamivudine + zidovudine) Anemia
Videx, or Videx-EC (didanosine or ddl) Diarrhea, abdominal pain, neuropathy, nausea, vomiting, pancreatitis Do not combine with stavudine.
Emtriva (emtricitabine) Rash and skin darkening of palms or soles, numbness, tingling, or burning sensation
Epzicom (abacavir + lamivudine) Nausea, vomiting, upset stomach, diarrhea, fatigue, chills, dizziness, headaches, insomnia Bactrim or Septra may increase blood levels; do not take with stavudine.
Epivir (lamivudine) Nausea, vomiting, upset stomach, diarrhea, fatigue, dizziness, headaches, insomnia
Zerit, Zerit XR (stavudine, d4T) Peripheral neuropathy, headache, chills & fever, diarrhea, nausea, fat loss in arms, legs, or face Do not combine with AZT or didanosine.
Viread (tenofovir) Mild nausea, vomiting, loss of appetite, upset stomach Do not use if you have kidney disease
Trizivir (abacavir + zidovudine + lamivudine) Anemia, nausea, stomach pain, diarrhea, constipation, vomiting, dizziness, insomnia, headache, fatigue, muscle aches, hypersensitivity reaction Tell your doctor about all medications you're taking.
Truvada (tenofovir + emtricitabine) Mild nausea, vomiting, loss of appetite, headache, rash, darkening of palms or soles, tingling, numbness, or burning sensation Do not take with didanosine or lamivudine or if you have kidney disease.
Stribild (tenofovir + emtricitabine + elvitegravir) Nausea, diarrhea Can cause lactic acid buildup and severe liver problems.

Retrovir (AZT, zidovudine)

Anemia, nausea, vomiting Do not combine with stavudine.

Triumeq (abacavir + lamivudine + dolutegravir)

Insomnia, headache, fatigue Do not combine with stavudine.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Common Side Effects Special Precautions
Edurant (rilpivirine) Depression, difficulty sleeping, headache, rash
Sustiva (efavirenz) Vivid dreams, anxiety, rash, nausea, insomnia
Viramune (nevirapine) Skin rash, fever, headache, nausea, diarrhea

Liver problems.

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Protease Inhibitors (PIs) Common Side Effects Special Precautions
Agenerase (amprenavir) Nausea, diarrhea, vomiting, rash
Reyataz (atazanavir) Elevated levels of bilirubin. Nausea, headache, rash, stomach pain, vomiting, diarrhea, depression, changes in heart rhythm. Effectiveness may be reduced if also taking ritonavir and Victrelis for hepatitis C.
Prezista (darunavir) Diarrhea, nausea, headache, skin rash Effectiveness may be reduced if also taking ritonavir and Victrelis for hepatitis C.
Lexiva (fosamprenavir) Nausea, diarrhea, vomiting, rash, numbness around mouth, abdominal pain
Kaletra (lopinavir/ritonavir) Diarrhea, fatigue, headache, nausea, weakness, rash, insomnia Effectiveness may be reduced if also taking Victrelis for hepatitis C.
Viracept (nelfinavir) Diarrhea, nausea, abdominal pain, weakness, rash, anemia, joint pain
Norvir (ritonavir) Nausea, vomiting, diarrhea, taste changes, headache, dizziness, rash
Aptivus (tipranavir) Elevated liver enzymes and cholesterol levels, diarrhea, rash, nausea, vomiting, stomach pain, fatigue, headache

Fusion Inhibitor (FI) Common Side Effects Special Precautions
Fuzeon (enfuvirtide) Redness, itching, or hard lumps at injection site, insomnia, depression, diarrhea, nausea, weakness, muscle pain, loss of appetite, weight loss, flu-like symptoms

Entry Inhibitor Common Side Effects Special Precautions
Selzentry (maraviroc) Cough, stomach pain, tiredness, dizziness when standing

Integrase Inhibitors Common Side Effects Special Precautions
Isentress (raltegravir) Headache, nausea, dizziness, tiredness, insomnia

Tivicay (dolutegravir) Headaches, insomnia

Vitekta (elvitegravir) Diarrhea, nausea, headache

Severe Side Effects of HIV Drugs

Here are examples of more severe HIV drug side effects:

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.

Continued

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 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 NNRTIs, NRTs, 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

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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, including fusion inhibitors, 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 March 21, 2018

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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