Side Effects of HIV Medicines

Lactic acidosis is a progressive condition caused by the buildup of lactic acid in the blood. Lactic acidosis is believed to cause damage to mitochondria, small organs inside cells that convert energy from food into energy that our body uses to function. 

Lactic acidosis is a rare but serious side effect of some HIV medicines in the nucleoside reverse transcriptase inhibitor (NRTI) drug class, such as lamivudine (3TC) and emtricitabine (FTC). While lactic acidosis is unlikely to be caused by modern HIV medicines, there is a possibility that it could result from some HIV medicines.

In addition to the use of some HIV medicines, risk factors for lactic acidosis include:

• Being female
• Pregnancy
• Obesity
• Poor liver function
• Low CD4 cell count

Even without the risk factors above, it can be helpful to understand the symptoms of lactic acidosis.

Lactic acidosis often develops gradually but can occur at any time. Early signs of lactic acidosis can include:

• Unexplained fatigue
• Persistent nausea and vomiting
• Weight loss

Since lactic acidosis can be life-threatening, it’s important to be mindful of these symptoms. If you are taking HIV medicines, always tell your health care provider about any symptoms that you are having—even symptoms that may not seem serious.

Lactic acidosis can rapidly advance to a life-threatening condition. Advanced signs of lactic acidosis include:

• Above-normal heart rate
• Rapid breathing
• Jaundice (yellowing of the skin and the whites of the eyes)
• Muscle weakness

If you are taking HIV medicines and have any of these symptoms, get medical help immediately.

Health care providers monitor people taking HIV medicines for side effects, like those caused by lactic acidosis. If an HIV medicine causes lactic acidosis, the HIV medicine should be stopped immediately, but only after consulting with your health care provider.

If your HIV medicine is causing lactic acidosis, your health care provider will change your HIV medicine based on your individual needs. Fortunately, there are many HIV medicines that can be included in an HIV treatment regimen. 

From the NIH Office of AIDS Research: 

• Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection:
  • Lactic Acidosis
• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: 
  • Adverse Effects of Antiretroviral Agents
  • What to Start: Initial Combination Regimens for People With HIV

From MedlinePlus: 

• Lactic Acidosis