Am Fam Physician. 2017;96(3):online
See related article on HIV-associated complications.
What side effects might I have from my HIV medicine?
HIV infection can cause problems with your nervous system, heart, stomach, liver, kidneys, bones, and metabolism. These problems can also be side effects of medicines used to treat HIV (called antiretroviral therapy, or ART). Side effects can happen when ART is taken with other medicines. If your doctor thinks that ART is causing serious problems, he or she may want you to switch to a different ART combination.
Below is a list of some common side effects of ART. If you're worried about side effects from one of your medicines, talk with your doctor before you stop taking it. Stopping ART can cause serious problems and can make your HIV harder to treat. Almost all ART medicines can cause a rash. But if you get a serious rash, talk to your doctor right away.
What can I do to prevent bone loss?
People with HIV infection can have low levels of vitamin D, which is important for bone health. A special kind of x-ray called a DEXA scan can check for bone loss. People at risk of bone loss include postmenopausal women, men 50 years and older, and people who have had broken bones. Talk to your doctor if you smoke, drink three or more alcoholic drinks per day, or have taken steroid medicines for a long time. Bone loss and low vitamin D levels are usually treated with medicine, calcium and vitamin D pills, and getting more exercise.
What can I do to prevent metabolic problems?
HIV infection and ART can cause body shape changes, glucose intolerance (pre-diabetes), diabetes, and high cholesterol. HIV medicines called nucleoside reverse transcriptase inhibitors (NRTIs, for short) are most commonly associated with body shape changes. You may lose fat in your face, arms, or legs, or gain weight around your waist or at the back of your neck. Talk to your doctor if you have any of these problems. Switching medicines can help. Cosmetic surgery may be an option for people with severe problems.
What can I do to prevent heart problems?
People with HIV infection are at higher risk of heart disease and stroke. You have an even higher risk if you smoke, have high cholesterol, high blood pressure, or diabetes, or if heart attacks run in your family. You can lower your risk by exercising and eating a healthy diet, and by taking medicine for your cholesterol, blood pressure, or diabetes. If you smoke, your doctor can help you quit.
What can I do to prevent kidney problems?
Talk with your doctor to see if you should be tested for kidney problems. If you are taking medicines that can cause serious kidney problems, talk with your doctor about switching to a different medicine.
What can I do to prevent liver problems?
Your doctor will test your liver regularly. You may also be tested for hepatitis, which can cause liver problems such as cirrhosis. You may need shots to keep you from getting some types of hepatitis. Alcohol can make liver problems worse, so talk to your doctor if you drink alcohol regularly.
How will my doctor check for side effects?
Your doctor will test your blood and urine. You should have a cholesterol test, kidney screening, and diabetes screening at least once per year. If you change your ART medicines, your doctor may also recheck your blood sugar and cholesterol levels.
What should I do if I have side effects?
Keep taking your medicines every day. If you are having a hard time doing this, let your doctor know as soon as you can. Talk to your doctor right away if you start having side effects, especially if you feel sick. Eat a healthy diet, exercise, and ask your doctor if you need to take vitamins.
If you have diabetes or cholesterol problems, ask your doctor whether you should change your diet or take medicines for these conditions. Make a list of all the medicines you take, including vitamins and supplements, and bring this list to each appointment. Your doctor will make sure it's safe to take these medicines with your ART.
| Side effect | Medicine |
|---|---|
| Bleeding problems | Tipranavir (brand name: Aptivus) may cause bleeding in the head |
| Body fat changes, lactic acidosis, pancreatitis | Didanosine (brand name: Videx) |
| Stavudine (brand name: Zerit) | |
| Zidovudine (brand name: Retrovir; also found in Combivir and Trizivir) | |
| Bone marrow problems | Zidovudine (brand name: Retrovir; also found in Combivir and Trizivir) |
| Bone problems | Boosted protease inhibitors |
| Efavirenz (brand name: Sustiva; also found in Atripla) | |
| Tenofovir disoproxil fumarate (brand name: Viread; also found in Truvada, Atripla, Complera, and Stribild) | |
| Cholesterol problems | All protease inhibitors |
| Abacavir (brand name: Ziagen; also found in Epzicom and Triumeq) | |
| Efavirenz (brand name: Sustiva; also found in Atripla) | |
| Elvitegravir/cobicistat (found in Stribild and Genvoya) | |
| Stavudine (brand name: Zerit) | |
| Diabetes | Many protease inhibitors |
| Increased risk of heart disease | Possibly abacavir (brand name: Ziagen; also found in Epzicom and Triumeq) |
| Lopinavir/ritonavir (brand name: Kaletra) | |
| Kidney stones | Atazanavir (brand name: Reyataz; also found in Evotaz) |
| Darunavir (brand name: Prezista; also found in Prezcobix) | |
| Fosamprenavir (brand name: Lexiva) | |
| Other kidney problems | Atazanavir (brand name: Reyataz; also found in Evotaz) |
| Tenofovir disoproxil fumarate (brand name: Viread; also found in Truvada, Atripla, Complera, and Stribild) | |
| Liver problems | All ART medicines can affect the liver, but especially didanosine (brand name: Videx), nevirapine (brand name: Viramune), stavudine (brand name: Zerit), and zidovudine (brand name: Retrovir; also found in Combivir and Trizivir) |
| Mood and sleeping problems | All integrase strand transfer inhibitors |
| Efavirenz (brand name: Sustiva; also found in Atripla) | |
| Rilpivirine (brand name: Edurant; also found in Complera and Odefsey) | |
| Muscle pain | All integrase strand transfer inhibitors, especially raltegravir (brand name: Isentress) and zidovudine (brand name: Retrovir; also found in Combivir and Trizivir) |
| Nail color changes | Emtricitabine (brand name: Emtriva; also found in Truvada, Descovy, Atripla, Complera, Odefsey, Stribild, and Genvoya) |
| Zidovudine (brand name: Retrovir; also found in Combivir and Trizivir) | |
| Nerve problems | Older NRTIs such as didanosine (brand name: Videx), stavudine (brand name: Zerit), and zidovudine (brand name: Retrovir; also found in Combivir and Trizivir) |
| Upset stomach, loose stools | All ART medicines can cause gastrointestinal problems at first |
| Some protease inhibitors can cause long-term stomach upset or changes in stools |
Where can I get more information?
Your doctor
AIDS Info
This handout was adapted with permission from Reust CE. Common adverse effects of antiretroviral therapy for HIV disease [patient handout]. Am Fam Physician. 2011;83(12):1443–1451. https://www.aafp.org/afp/2011/0615/p1456.html. Accessed April 5, 2017.
