Common Side Effects of HIV Medications

Researchers are learning more about HIV with each day. This has allowed for new treatment options to arise with antiretroviral medications. Fortunately, many of these newer drugs have fewer side effects than the older (or original) options.1

Talk to your doctor about medication side effects

There is still a long way to go when it comes to learning about the potential side effects, both short- and long-term, of HIV drugs. Some of the most common side effects for each type of drug are listed below. These are not exhaustive lists of all potential effects.

If you notice any new, worsening, or intolerable side effect, contact your doctor. They may be able to recommend options to help reduce the side effect or suggest a new drug type to try.

Common side effects of ARVs

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)

NRTIs include drugs like emtricitabine, lamivudine, tenofovir disoproxil, abacavir, and zidovudine. The most common side effects with this group include but are not limited to:1-3

  • Nausea and vomiting
  • Diarrhea, gas, or abdominal pain
  • Headache or dizziness
  • Weakness, tiredness, or general feeling of being unwell
  • Rash
  • Muscle or joint pain
  • Insomnia or abnormal dreams (emtricitabine and tenofovir disoproxil)
  • Changes in liver, kidney, or pancreas function tests (emtricitabine and tenofovir disoproxil)
  • Changes in the amount of sugar or fat in the blood (emtricitabine, zidovudine, and abacavir)
  • Cough or runny nose (lamivudine)
  • Hair loss (lamivudine)
  • Bone thinning (especially tenofovir disoproxil)
  • Low blood cell counts (zidovudine)
  • Increased risk of diabetes (zidovudine)
  • Increased levels of acid and breakdown products in the blood called lactic acidosis (zidovudine)
  • Allergic hypersensitivity reactions (abacavir)
  • Increased risk of heart attack (abacavir)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

NNRTIs include drugs like doravirine, efavirenz, etravirine, nevirapine, and rilpivirine. The most common side effects with this group include, but are not limited to:1-3

  • Abnormal dreams, insomnia, drowsiness, or difficulty sleeping
  • Mood changes, including depression or anxiety
  • Headache, disturbed concentration, or dizziness
  • Nausea and vomiting
  • Abdominal pain, indigestion, gas, or acid reflux
  • Rash or itching
  • Reduced blood cell counts (etravirine and rilpivirine)
  • Heart rhythm changes (efavirenz and rilpivirine)
  • Changes in liver or pancreas function tests (efavirenz, nevirapine, rilpivirine)
  • Changes in the amount of sugar or fat in the blood (efavirenz, etravirine, and rilpivirine)
  • High blood pressure (etravirine and nevirapine)
  • Increased risk of heart attack, kidney failure, or diabetes (etravirine)
  • Tingling of the hands and feet (etravirine)
  • Allergic reaction (nevirapine)

Protease inhibitors

Protease inhibitors include drugs like atazanavir, darunavir, and lopinavir. Sometimes, these are combined with another drug called cobicistat or ritonavir. These added drugs enhance the protease inhibitor’s effects. The most common side effects with this group include, but are not limited to:1-3

  • Nausea, vomiting, or change in appetite
  • Diarrhea, gas, heartburn, or abdominal pain
  • Tiredness or changes in sleep
  • Headache
  • Increased levels of fat in the blood
  • Rash or yellowing of the skin (caused by increased bilirubin in the blood)
  • Fever (darunavir)
  • Tingling of the hands and feet (darunavir)
  • Diabetes and changes in body fat distribution (darunavir and lopinavir)
  • Changes in liver, kidney, or pancreas function tests (darunavir)
  • Heart rhythm changes (atazanavir and lopinavir)
  • Bleeding issues (for people with pre-existing hemophilia)

When combined with cobicistat or ritonavir, additional common side effects include but are not limited to:1-3

  • Altered sense of taste
  • Dry mouth
  • Abnormal dreams
  • Inflammation of the pancreas (pancreatitis)
  • Cough, sore throat, runny nose, or sinus infections
  • Skin infections or itchiness
  • Muscle pain
  • Erectile dysfunction
  • Menstrual cycle irregularities
  • Allergic reactions

Integrase inhibitors

Integrase inhibitors include drugs like dolutegravir, elvitegravir, and raltegravir. The most common side effects with this group include, but are not limited to:1-3

  • Nausea, vomiting, or change in appetite
  • Diarrhea, gas, or abdominal pain
  • Headache, dizziness, or vertigo
  • Rash or itching
  • Abnormal dreams, restlessness, and difficulty sleeping
  • Fatigue or weakness
  • Changes in liver or pancreas function tests
  • Weight gain
  • Depression (raltegravir)
  • Increased fat levels in the blood (elvitegravir and raltegravir)

Entry/fusion inhibitors

Entry and/or fusion inhibitors include drugs like maraviroc and ibalizumab. The most common side effects with this group include, but are not limited to:1-3

  • Dizziness and low blood pressure when standing
  • Nausea
  • Diarrhea, abdominal pain, changes in appetite, or bloating
  • Weakness
  • Trouble sleeping
  • Rash
  • Depression
  • Anemia (low red blood cell counts)
  • Changes in liver or kidney function tests
  • Allergic hypersensitivity reactions

Side effects when combining medication types

Some HIV treatment regimens involve more than one type of drug. Sometimes multiple pills may be required each day. Other times, one combination pill may be prescribed.

Side effects may change when combining different drug types. For information on the side effects that may come along with your combined treatment regimen, talk with your doctor.1,2

Switching medications

Newer medications tend to have fewer side effects than older drugs. However, some people may need to change their treatment regimen due to intolerable or undesirable side effects. Keep open lines of communication with your doctor about side effects, and alert them as soon as you notice anything new.

Some side effects are minor and go away over time, but others can be more serious. Your doctor can help you determine which category your side effects fall into.

What to consider when changing medications

There are many things to consider before changing from one drug type to another. These decisions will vary from person to person and carry different risks and benefits. Some of these considerations include:1

  • Potential resistance to a new drug
  • Potential for different side effects
  • New food or dosing requirements
  • Drug costs
  • Other drug interactions

Talk with your doctor about other treatment options if you are interested in switching your current plan.

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