Side Effects of HIV Medicines

Side effects are symptoms or problems that may occur when taking any medicine, including HIV medicine. Specifically, HIV medicines help people with HIV live long, healthy lives, and can also reduce the risk of HIV transmission. 

As with most medications, HIV medicines can sometimes cause side effects. Most side effects from HIV medicines are manageable and will not cause serious problems, but a few can be serious.

Overall, the benefits of FDA-approved HIV medicines far outweigh the risk of side effects. In addition, HIV medicines have been improved over the years to cause fewer side effects, making people less likely to have side effects from HIV medicines.

If you are starting HIV medicines or if you are starting a new HIV medicine, you should discuss the possible side effects of the medication with your health care provider. Health care providers work with you to select an HIV treatment regimen based on your individual needs. 

If you experience side effects from an HIV medicine, consult with your health care provider. Always call your health care provider before you stop taking the medicine.

Different HIV medicines can cause different side effects. In addition, people taking the same HIV medicine can have different side effects.

Some side effects from HIV medicines are very common and may last only a few days or weeks. For example, nausea, fatigue, and sleep problems are some short-term side effects of HIV medicines.

HIV medicines can also cause other side effects that may not appear for months or years after starting a medicine. For example, high cholesterol—a major risk factor for heart disease—can be a side effect of some HIV medicines.

Having another medical condition or taking other medicines can increase the risk of side effects from HIV medicines. In addition, drug-drug interactions between HIV medicines and other medicines can also cause side effects.

Use the Clinicalinfo Drug Database to learn more about your HIV medicines, including possible side effects. For help using the Drug Database, contact a Clinicalinfo health information specialist by phone (1-800-448-0440) or email (HIVinfo@NIH.gov).

Before starting HIV medicines, talk to your health care provider about possible side effects.

In some cases, possible side effects can be avoided by precautionary testing. For example, the HIV drug abacavir (ABC) can cause hypersensitivity and a severe rash in patients with a particular genetic makeup. Before starting treatment with abacavir, the FDA recommends that all patients take a genetic test to predict their susceptibility to a serious hypersensitivity reaction.

Depending on the HIV medicines in your HIV treatment regimen, your health care provider will:

• Tell you which specific side effects to look out for.
• Give you suggestions on how to deal with manageable side effects like nausea and vomiting.
• Tell you about the signs of life-threatening side effects that require immediate medical care, like swelling of the mouth and tongue.

Once you start taking HIV medicines, tell your health care provider about any side effects that you are having. Your health care provider can recommend ways to treat or manage side effects.

In some cases, it may be necessary to change HIV medicines to stop a side effect. However, do NOT cut down on, skip, or stop taking your HIV medicines unless your health care provider tells you to. 

Fortunately, there are many HIV medicines available as alternatives to include in an HIV treatment regimen. Your individual needs will determine the choice of HIV medicines to replace those causing side effects.

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

From U.S. Food and Drug Administration: 

• HIV and AIDS: Medicines to Help You

From the National Institute of Allergy and Infectious Diseases: 

• HIV/AIDS Treatment

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

Diabetes is a disease that develops when levels of blood glucose (also called blood sugar) are too high. Glucose comes from the breakdown of the foods we eat and is the body’s main source of energy.

Over time, diabetes can cause serious health problems, including heart disease, stroke, kidney disease, eye problems, and nerve damage.

There are different types of diabetes: type 1, type 2, and gestational. This fact sheet discusses type 2 diabetes, which is the most common type of diabetes.

People at an increased risk of type 2 diabetes include those who:

• Are 45 years of age or older
• Have a family history of diabetes
• Are overweight or obese
• Do not engage in regular physical activity
• Are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American

People with HIV have additional unique risk factors for developing diabetes. Risk factors for diabetes in people with HIV include:

• Taking specific HIV medicines, including older-generation drugs (such as ritonavir)
• Having lipodystrophy
• Having hepatitis C 
• Having HIV-related inflammation

If you have HIV and any of the risk factors above, it is important to be aware of potential symptoms of diabetes.

Diabetes is associated with many symptoms which include:

• Increased thirst
• Frequent urination 
• Increased hunger 
• Unusual weight loss 
• Fatigue  
• Blurred vision 
• Tingling or numbness in the hands or feet
• Sores that do not heal

If you have HIV and are experiencing any of these symptoms, be sure to consult your health care provider to protect yourself from diabetes or other harmful conditions.

You should have your blood glucose levels checked before starting treatment with HIV medicines. Some HIV medicines should be avoided by people with high blood glucose levels.

Even if you don’t have diabetes, your health care provider may want to regularly check your blood glucose to make sure it stays at a healthy level.

You can take the following steps to prevent, delay, or manage type 2 diabetes:

• Maintain a healthy weight. If you are overweight, lose weight and keep it off.
• Eat healthily. Eat a variety of healthy foods (see MyPlate.gov for recommendations) and limit foods high in fat, sugar, and salt.
• Keep moving. Aim to get in at least 30 minutes of physical activity on most days of the week.

In addition to the above measures, some medicines can help manage type 2 diabetes. To learn more, visit the Managing Diabetes webpage from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

If you have HIV, talk to your health care provider about your risk for diabetes and what you can do to protect your health. The best way to reduce your risk of diabetes is to take care of yourself by maintaining a proper diet, exercising regularly, and taking your HIV medicines as prescribed. 

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 
  • Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral Suppression

From the U.S. Department of Agriculture:

• MyPlate

From the U.S. Department of Veterans Affairs: 

• Primary Care of Veterans with HIV: Diabetes Mellitus

From NIDDK: 

• Diabetes Overview

From the National Library of Medicine:

• Diabetes in People Living with HIV. [Updated 2023 Nov 1]. Sarkar S., and Brown T.T. In: Feingold K.R., Anawalt B., Blackman M.R., et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545886/

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

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. 

High cholesterol (hyperlipidemia) refers to high levels of total cholesterol in the blood. Cholesterol is a waxy, fat-like substance made by the body and is also found in foods from animal sources, such as egg yolks, meat, and cheese.

Total cholesterol refers to the total amount of low-density lipoprotein (LDL; bad cholesterol) and high-density lipoprotein (HDL; good, protective cholesterol) in the blood. In short, a lot of LDL is a bad thing, but a lot of HDL is a good thing. However, both are still counted when total cholesterol is measured.

While the body needs cholesterol to function properly, too much (specifically LDL) can cause health problems. For example, high cholesterol increases the risk of cardiovascular disease. 

The most common causes of high cholesterol are unhealthy lifestyle habits, including the following:

• Eating foods high in dietary fats, including saturated and trans fats
• Lack of physical activity (sedentary lifestyle)
• Smoking

Other potential risk factors for high cholesterol include:

• Older age
• A family history of high cholesterol
• Other medical conditions, such as diabetes
• Being overweight or obese
• Certain medicines

Some HIV medicines, such as abacavir (ABC) and ritonavir (RTV), may increase the risk of high cholesterol by increasing LDLs, which puts people with HIV at a higher risk of developing hyperlipidemia. In addition, these same medicines may directly increase blood triglycerides, further increasing disease risk.

Usually, high cholesterol has no symptoms. However, a blood test can be used to measure total cholesterol levels.

Cholesterol testing is recommended before and after a person starts taking HIV medicines. If cholesterol levels are normal, testing is recommended once a year. If cholesterol levels are too high, more frequent testing is recommended.

• Eat a healthy diet. Eat foods low in saturated fat, trans fat, and cholesterol. Choose low-fat or fat-free dairy products, eat more high-fiber foods, and eat more vegetables and fruits. Visit Myplate.gov for helpful dietary guidance.
• Get active. Try to get at least 30 minutes of physical activity on most days of the week.
• Maintain a healthy weight. If you are overweight or obese, losing weight can improve cholesterol levels.
• Quit smoking. To find tips and tools to help you quit smoking, visit the Department of Health and Human Services’ Smokefree.gov website.

Treatment for high cholesterol begins with the lifestyle changes outlined above. Sometimes a cholesterol-lowering medicine is also needed—with statins being the most common drug type.

In people with HIV, treatment for high cholesterol may involve changing an HIV treatment regimen to avoid taking HIV medicines that can increase cholesterol levels.

Some HIV medicines can have negative interactions with cholesterol medicines. Health care providers carefully consider potential drug-drug interactions between HIV medicines and any other medicines a person may be taking.

From the NIH Office of AIDS Research: 

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

  • Statin Therapy in People With HIV

  • Adverse Effects of Antiretroviral Agents 

  • Laboratory Testing

From the Centers for Disease Control and Prevention:

• LDL and HDL Cholesterol and Triglycerides

From the Health Resources and Services Administration: 

• Guide for HIV/AIDS Clinical Care: Dyslipidemia 

From MedlinePlus: 

• Cholesterol 

• How to Lower Cholesterol with Diet

From the National Heart, Lung, and Blood Institute (NHLBI): 

• Your Guide to Lowering Your Cholesterol With TLC

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

Lactic acidosis is a condition caused by the buildup of lactic acid in the blood. The condition is a rare but serious side effect of some HIV medicines in the nucleoside reverse transcriptase inhibitor (NRTI) drug class.

Women and people who are obese may have an increased risk of developing lactic acidosis if they are taking NRTIs.

Although lactic acidosis is a rare side effect of NRTIs, the condition can be life-threatening. Fortunately, lactic acidosis is less likely to occur with newer NRTIs than with NRTIs used in the past.

Lactic acidosis often develops gradually. Early signs of lactic acidosis can include fatigue, nausea, vomiting, and weight loss. These symptoms may not seem serious, but they can be the first signs of life-threatening lactic acidosis. 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 advance rapidly. Signs of life-threatening lactic acidosis include the following:

• Above-normal heart rate
• Rapid breathing
• Yellowing of the skin and the whites of the eyes (jaundice)
• 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, such as lactic acidosis. If an HIV medicine is causing lactic acidosis, the HIV medicine should be stopped immediately. However, stopping an HIV medicine because of lactic acidosis does not mean stopping HIV treatment. Choosing an HIV medicine to replace one that is causing lactic acidosis will depend on a person’s individual needs. Fortunately, there are many HIV medicines that can be included in an HIV treatment regimen.

From the Department of Health and Human Services:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • Adverse Effects of Antiretroviral Agents
  • What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient

From MedlinePlus:

• Lactic Acidosis

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

Lipodystrophy is a condition that changes the way your body makes, uses, and stores fat. Lipodystrophy is also known as fat redistribution, in which the body abnormally takes fat from one region of the body and relocates it to another part of the body.

The way lipodystrophy affects each person can vary based on numerous factors, including gender. For example, women tend to have fat buildup (also called lipohypertrophy) that occurs:

• Around the organs in the belly
• On the back of the neck between the shoulders
• In the breasts

In contrast, men tend to have fat loss (also called lipoatrophy) that occurs:

• In the arms and legs
• Around the hips
• On the face

People with lipodystrophy often have other metabolic problems, including high cholesterol and insulin resistance, which can lead to diabetes. If untreated, metabolic problems caused by lipodystrophy can also lead to other conditions, such as heart disease.

While the exact cause of lipodystrophy remains unknown, it may be attributed to HIV. In addition, some HIV-related medicines could cause lipodystrophy, particularly after long-term use. Some HIV medicines that have been linked to lipodystrophy include atazanavir, darunavir, fosamprenavir, ritonavir, and tipranavir.

If you are currently taking any of these medicines and believe you are experiencing lipodystrophy, you should consult with your health care provider to determine if you need to adjust your treatment regimen. Do not stop taking your current HIV medicine unless your doctor advises you to do so.

Aside from HIV and HIV-related medicines, some evidence suggests an increased risk of lipodystrophy in people who are:

• Women
• Black
• Genetically predisposed
• Underweight or overweight
• Older

If you believe you are at an increased risk of lipodystrophy, it’s important to understand your treatment options.

If you have HIV and think you also have lipodystrophy, talk to your health care provider about treatment options, including potential changes to your HIV medicine. Never stop taking your HIV medicines without consulting your doctor. A health care provider could also prescribe non-HIV medicines to help treat lipodystrophy. 

Aside from changing medicines, the effects of lipodystrophy could be reduced through dietary changes and regular exercise. In other cases, liposuction (surgical fat removal) and injectable facial fillers are sometimes used to treat lipodystrophy.

From the NIH Office of AIDS Research: 

• Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection:
  • Lipodystrophies and Weight Gain
• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: 
  • Adverse Effects of Antiretroviral Agents

From the Department of Veterans Affairs: 

• FAQ: Will HIV medicines cause changes to your fat and stomach?

From the New York State Department of Health

• Managing Side Effects of HIV Medications

From the Health Resources and Services Administration: 

• Guide for HIV/AIDS Clinical Care: Abnormalities of Body-Fat Distribution

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

Osteoporosis is a bone disease that weakens the bones and increases the risk of fractures. While the risk of fractures increases throughout the body in people with osteoporosis, the risk is most noticeable in the hips, spine, and wrists. A milder form of bone loss is known as osteopenia.

There is a clear link between HIV infection, some HIV-related medicines, and bone loss. If untreated, prolonged bone loss could result in osteoporosis. 

There are many risk factors for osteoporosis. Some risk factors cannot be changed, while others can be controlled by lifestyle choices.

Risk factors for osteoporosis that cannot be changed include:

• Age: The risk of osteoporosis increases as people get older.
• Gender: Compared to men, women have smaller bones and lose bone faster due to hormonal changes after menopause.
• Race and ethnicity: The risk of osteoporosis is greatest for White and Asian women.
• Family history: Osteoporosis tends to be genetic.

The following risk factors for osteoporosis can be controlled by lifestyle choices:

• Poor diet: A diet low in calcium and vitamin D increases the risk of osteoporosis.
• Physical inactivity: Physical inactivity tends to weaken bones.
• Smoking: Smoking increases the risk of osteoporosis.
• Alcohol: Too much alcohol can cause bone loss and broken bones. 

Certain HIV medicines, such as tenofovir disoproxil fumarate (TDF), have been linked to bone loss. In contrast, vitamin D and calcium supplements can increase bone mineral density in participants taking TDF-based drugs. If your doctor suspects that TDF or another HIV medicine is lowering your bone density, they may switch you to another HIV medicine.

Bone loss that leads to osteoporosis generally occurs without symptoms. The first sign of osteoporosis is often a broken bone after a minor fall. Osteoporosis can also cause tiny fractures in your spine that cause back pain.

A bone mineral density test (also called dual-energy x-ray absorptiometry) is used to measure bone health. This painless test is used to diagnose osteopenia and osteoporosis.

If you have HIV, you may want to discuss bone mineral density testing with your health care providers while also taking precautionary steps to prevent osteoporosis.

You can take the following steps to prevent osteoporosis:

• Eat a healthy diet rich in calcium and vitamin D. Calcium-rich foods include milk, dairy products, broccoli, sardines, tofu, and almonds. Meanwhile, milk, egg yolks, saltwater fish, and liver are high in vitamin D. Alternatively, you can also take calcium and vitamin D supplements. 
• Stay active. Weight-bearing physical activities, such as walking and lifting weights, can make bones stronger and help slow down bone loss. 
• Do not smoke. Smoking is associated with bone density loss and increases the risk of broken bones the longer and more often you smoke.
• Cut down on alcohol. If you drink alcohol, drink in moderation. Too much alcohol can damage bones and increase the risk of falling.

Osteoporosis treatment includes regular exercise and eating a healthy diet that is rich in calcium and vitamin D. While there are also medicines to help prevent and treat osteoporosis, lifestyle choices are essential to long-term bone health.

People with osteoporosis should also take measures to avoid falls that can lead to broken bones. For example, they may use a cane or walker to help prevent such accidents.

For people with HIV, regular bone density testing could help reduce the risk of osteoporosis. If you have HIV and believe you are at risk for osteoporosis, be sure to consult with your health care provider in case a change to your treatment regimen is necessary. 

From the National Institute of Arthritis and Musculoskeletal and Skin Diseases:

• Osteoporosis Causes and Symptoms
• Bone Health and Osteoporosis

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 

  • Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral Suppression

From MedlinePlus:

• Exercise, Lifestyle, and Your Bones

From the Office on Women's Health

• Osteoporosis

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

A rash is an irritated or swollen area of skin that may be itchy, red, bumpy, and painful. Possible causes of a rash in people with HIV include:

• Acute HIV
• Other infections
• Medicines

Acute HIV 
A rash may be an early symptom of HIV infection. During the earliest stages of HIV, a rash can develop as the body fights off the virus, weakening the immune system.

Other infections
Without treatment, HIV gradually destroys the immune system. Damage to the immune system increases the risk of other infections such as herpesviruses and molluscum contagiosum that cause rashes and skin conditions. While a rash may be directly related to HIV, it can also be a symptom of many other infections. 

Medicines 
Many medicines, including some HIV medicines, can cause a rash. Examples of HIV medicines that may cause a rash include efavirenz (EFV) and darunavir (DRV). 

Rashes from EFV often appear in the first two weeks of treatment as pink or red-colored patches with or without raised bumps. In contrast, rashes from DRV often occur weeks to months after starting treatment and are typically darker (red or purple) and more likely to blister or peel.

A rash caused by HIV medicine is typically not serious and goes away in several days to weeks without treatment. However, it may be necessary to switch to another HIV medicine if a rash develops and won’t go away, or if other symptoms like fever, blisters, joint pain, or fatigue also occur.

If you are taking HIV medicine, tell your health care provider if you have a rash. In rare cases, a rash caused by an HIV medicine can be a sign of a serious condition. Never stop taking your HIV medication without talking to your doctor.

A rash can be a sign of a hypersensitivity reaction, which is a potentially serious allergic reaction to a medicine. In addition to a rash, signs of a hypersensitivity reaction can include difficulty breathing, dizziness, or lightheadedness. A severe hypersensitivity reaction can require immediate medical attention.

Stevens-Johnson syndrome (SJS) is a rare but serious hypersensitivity reaction reported with the use of some HIV medicines, including nevirapine (NVP). SJS may cause symptoms such as fever, rash, painful blisters, and other flu-like symptoms. 

Given the severity of SJS, people taking HIV medicine should know about this condition. If you have symptoms of SJS, get medical help immediately. SJS can be life-threatening.

Treatment of HIV-related skin rashes depends on the cause. If you think you have been exposed to HIV and developed a rash, see your health care provider immediately. HIV medicines can help restore the immune system and reduce viral load, leading to significant improvement in HIV-related skin conditions.

If your rash is caused by an HIV medicine, switching to another medicine should help the rash go away. Otherwise, consult with your health care provider if you have concerns about any rash or rash related to an HIV medicine. Never stop taking your HIV medications without talking to your doctor.

From the NIH Office of AIDS Research: 

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: 
  • Early (Acute and Recent) HIV Infection 
  • Adverse Effects of Antiretroviral Agents 

From MedlinePlus: 

• Drug Allergies
• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

From the United States Food and Drug Administration:

• ATRIPLA Drug Label
• PREZISTA Drug Label