Side Effects of HIV Medicines

Hepatotoxicity is the medical term for liver damage caused by a medicine (prescription or over-the-counter), chemical, or supplement (herbal or dietary). Hepatotoxicity, also called toxic liver disease or toxic hepatitis, can be a side effect of some HIV medicines. 

Use the Clinicalinfo Drug Database to find information about a specific HIV medicine, including information about its potential side effects. If untreated, hepatotoxicity can cause short-term liver damage (cirrhosis) or even long-term liver failure. People with an increased risk of hepatotoxicity should be aware of the symptoms of this condition.

In people with HIV, hepatotoxicity may result directly from HIV infection, another liver disease, or an HIV-related medicine (such as efavirenz (EFV) and some protease inhibitors). The following factors may increase the risk of hepatotoxicity due to HIV medicines:

• Other liver diseases: hepatitis B virus (HBV) and/or hepatitis C virus (HCV)
• Taking other medicines that can cause liver damage.
• Alcohol use, which can cause liver damage.
• Pre-existing liver damage.

If you believe you are at increased risk of hepatotoxicity due to any of the reasons above, you will want to be mindful of any associated symptoms. 

Symptoms of hepatotoxicity include the following:

• Rash
• Stomach pain
• Nausea and vomiting
• Fatigue
• Dark-colored urine
• Diarrhea
• Light-colored bowel movements
• Jaundice (yellow skin and eyes)
• Itching
• Loss of appetite
• Fever

People taking HIV medicines that may cause hepatotoxicity should know about these symptoms. In some cases, hepatotoxicity can be life-threatening. If you have any of these symptoms, contact your health care provider immediately.

Several lab tests are done when people start taking HIV medicines, including blood tests to check for liver damage and infections like HBV and HCV. If the health care provider suspects the person is at risk for developing hepatotoxicity, they can avoid prescribing HIV medicines that cause hepatotoxicity.

People taking HIV medicines are monitored for signs of hepatotoxicity. If HIV medicines are causing serious hepatotoxicity, they must be stopped immediately. However, you should never stop taking an HIV medicine unless your health care provider tells you to.

There are many HIV medicines available for an HIV treatment regimen. Choosing a replacement for an HIV medicine that is causing hepatotoxicity will depend on individual needs.

If you are taking or plan to take HIV medicines, talk to your health care provider about the risk of hepatotoxicity.

Beyond the treatment considerations mentioned above, the strategies for preventing and treating hepatotoxicity in people with HIV are essentially identical to those without HIV:

• Reducing or eliminating alcohol use
• Reducing weight in people who are overweight or obese
• Updating vaccinations to protect against other forms of liver disease

From MedlinePlus: 

• Drug-Induced Liver Injury

From the NIH National Library of Medicine: 

• LiverTox: Glossary

From the NIH Office of AIDS Research: 

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: 

  • Adverse Effects of Antiretroviral Agents 

  • Laboratory Testing for Initial Assessment and Monitoring of People With HIV Receiving Antiretroviral Therapy 

From the U.S. Department of Veterans Affairs: 

• Primary Care of Veterans with HIV

Also see the HIV Source collection of HIV links and resources.