Side Effects of HIV Medicines

HIV medicines help people with HIV live longer, healthier lives. HIV medicines also reduce the risk of HIV transmission. But HIV medicines can sometimes cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious.

Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV medicines cause fewer side effects than medicines used in the past. As HIV treatment continues to improve, people are less likely to have side effects from HIV medicines.

Before starting HIV medicines, people with HIV discuss possible side effects from HIV medicines with their health care providers. They work together to select an HIV treatment regimen based on the person’s individual needs.

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

Side effects from HIV medicines may last only a few days or weeks. For example, nausea, fatigue, and trouble sleeping are some short-term side effects of HIV medicines.

Other side effects from some HIV medicines can lead to problems that may not appear for months or years after starting a medicine. For example, high cholesterol can be a side effect of some HIV medicines. High cholesterol is a risk factor for heart disease.

Having another medical condition or taking other medicines can increase the risk of side effects from HIV medicines. Drug-drug interactions between HIV medicines or with other medicines a person is taking 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 an 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.

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 side effects that are manageable. For example, to manage nausea and vomiting, eat small meals and avoid spicy foods.
• Tell you about the signs of life-threatening side effects that require immediate medical care. One example is swelling of the mouth and tongue.

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

In some cases, it may be necessary to change HIV medicines because of 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 to include in an HIV treatment regimen. The choice of HIV medicines to replace those causing side effects will depend on a person’s individual needs.

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

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 glucose in the blood (also called blood sugar) are too high. Glucose comes from the breakdown of the foods we eat and is our 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, including type 1 diabetes, type 2 diabetes, and gestational diabetes. This fact sheet discusses type 2 diabetes, which is the most common type of diabetes.

Risk factors for type 2 diabetes include being 45 years of age or older, having a family history of diabetes, being overweight or obese, and lack of physical activity. People whose family background is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American are at greater risk of type 2 diabetes.

People with HIV are more likely to have type 2 diabetes than people without HIV. Additionally, some HIV medicines may increase the risk of type 2 diabetes in people with HIV.

The symptoms of diabetes can 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

People who have symptoms of diabetes should get tested for the disease. Testing is also recommended for people with certain risk factors for diabetes. Blood tests are used to measure blood glucose levels and diagnose diabetes.

People with HIV should have their blood glucose levels checked before starting treatment with HIV medicines. People with higher-than-normal glucose levels may need to avoid taking some HIV medicines.

Blood glucose testing is also important after starting HIV medicines. If testing shows high glucose levels, a change in HIV medicines may be necessary.

You can take the following steps to lower your risk of developing type 2 diabetes:

• Maintain a healthy weight. If you are overweight, lose weight and keep it off.
• Eat healthy. Eat a variety of healthy foods and limit foods high in fat, sugar, and salt.
• Keep moving. Aim for 30 minutes of physical activity on most days of the week.

People who have type 2 diabetes can also follow these steps to manage the disease. In addition, some people may take medicine to manage their 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.

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
  • Laboratory Testing
  • Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral Suppression

From the U.S. Department of Veterans Affairs:

• Primary Care of Veterans with HIV: Diabetes Mellitus

From NIDDK:

•  Diabetes Overview

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

Hepatotoxicity is the medical term for damage to the liver caused by a medicine, chemical, or herbal or dietary supplement. Hepatotoxicity 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.

The following factors may increase the risk of hepatotoxicity due to HIV medicines:

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

Symptoms of hepatotoxicity include the following:

• Rash
• Stomach pain
• Nausea and vomiting
• Fatigue
• Dark-colored urine
• Light-colored bowel movements
• Jaundice (yellow skin and eyes)
• 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.

Before starting HIV medicines, people with HIV have several lab tests done. These include blood tests to check for liver damage and for HBV and HCV infection. If the test results and other information shows that the person is at risk for developing hepatotoxicity, they can avoid HIV medicines that may cause hepatotoxicity.

Once a person starts taking HIV medicines, they are monitored for signs of hepatotoxicity. HIV medicines that are causing serious, life-threatening hepatotoxicity must be stopped immediately. However, a person should never stop taking an HIV medicine unless their health care provider tells them to.

Choosing an HIV medicine to replace one that is causing hepatotoxicity will depend on a person’s individual needs. Fortunately, there are many HIV medicines available to include in an HIV treatment regimen.

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

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
  • Laboratory Testing

From MedlinePlus:

• Drug-Induced Liver Injury

From the National Institutes of Health:

• LiverTox: Glossary

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

The body needs cholesterol to function properly but having too much can cause problems. High cholesterol increases the risk of heart disease.

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

• Eating foods high in saturated fat, trans fat, and cholesterol
• Lack of physical activity
• Smoking

The following are additional risk factors for high cholesterol:

• Age—as people get older, their cholesterol levels tend to rise
• A family history of high cholesterol
• Other medical conditions, such as diabetes
• Being overweight or obese
• Certain medicines

Some HIV medicines may also increase the risk of high cholesterol in people with HIV.

Usually, high cholesterol has no symptoms. A blood test is used to measure 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.

People can take these steps to prevent high cholesterol or lower cholesterol levels.

• Eat a healthy diet. Eat foods low in saturated fat, trans fat, and cholesterol. Choose low-fat or fat-free dairy products, eat more foods that are high in fiber, and eat more vegetables and fruits.
• 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 lifestyle changes. Sometimes cholesterol-lowering medicine is also needed. The most common medicines used to reduce cholesterol levels are called statins.

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

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

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
  • Laboratory Testing

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 refers to the changes in body fat that can affect some people with HIV. Lipodystrophy can include buildup of body fat, loss of body fat, or both.

Fat buildup (also called lipohypertrophy) can occur:

• Around the organs in the abdomen
• On the back of the neck between the shoulders (called a buffalo hump)
• In the breasts

Fat loss (also called lipoatrophy) tends to occur:

• In the arms and legs
• In the buttocks
• In the face

Lipodystrophy may be due to HIV infection or medicines used to treat HIV, but its actual cause is not understood. Newer HIV medicines are less likely to cause lipodystrophy than HIV medicines developed in the past.

Lipodystrophy is not a concern for most people who start HIV treatment now, because newer HIV medicines are less likely to cause lipodystrophy.

If you have lipodystrophy, talk to your health care provider about treatment options. Your health care provider may recommend that you switch to another HIV medicine.

There are ways to manage lipodystrophy. Making dietary changes and getting regular exercise may help to build muscle and reduce abdominal fat.

Liposuction (surgical removal of fat) and injectable facial fillers are sometimes used to treat lipodystrophy. There are also medicines that may help lessen the effects of lipodystrophy.

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

From the Department of Veterans Affairs:

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

From the Health Resources and Services Administration:

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

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

Osteoporosis is a disease that develops due to bone loss. The bones of people with osteoporosis become weak and are more likely to break. Osteoporosis increases the risk of broken bones of the hip, spine, and wrist.

The risk of osteoporosis increases as people age. Anyone can get osteoporosis, but it is most common in older women.

HIV infection and some HIV medicines may increase the risk of osteoporosis in people with HIV. 

There are many risk factors for osteoporosis. Some risk factors cannot be changed, while other risk factors can be managed with 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/ethnicity: The risk of osteoporosis is greatest for White and Asian women.
• Family history: Osteoporosis tends to run in families.

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.

Bone loss that leads to osteoporosis occurs without symptoms. The first sign of osteoporosis is often a broken bone.

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

People with HIV may wish to discuss bone mineral density testing with their health care providers.

People can take the following steps to prevent osteoporosis.

• Eat a healthy diet rich in calcium and vitamin D. Foods high in calcium include milk and other dairy products, broccoli, sardines, tofu, and almonds. Milk is fortified with vitamin D. Egg yolks, saltwater fish, and liver are also high in vitamin D. People can also take calcium and vitamin D supplements.
• Stay active. Physical activities, such as walking and lifting weights, can make bones stronger and help slow down bone loss.
• Do not smoke.
• Cut down on alcohol. If you drink alcohol, drink in moderation.

Treatment for osteoporosis includes eating a healthy diet rich in calcium and vitamin D and getting regular exercise to improve bone health. There are also medicines to help prevent and treat osteoporosis.

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

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

• Osteoporosis

From the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center:

• Osteoporosis Overview

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
  • Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral Suppression

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

A rash is an irritated area of the skin that is sometimes itchy, red, and painful. Possible causes of a rash in people with HIV include:

• Acute HIV infection
• Other infections
• HIV medicines
• Other medicines

Acute HIV infection

Acute HIV infection is the earliest stage of HIV infection. Symptoms of acute HIV infection may include a rash.

Other infections

Without treatment, HIV gradually destroys the immune system. Damage to the immune system puts people with HIV at risk of infections, and a rash is a symptom of many infections.

Medicines

Many medicines, including some HIV medicines, can cause a rash.

A rash due to an HIV medicine is often not serious and goes away in several days to weeks without treatment. But sometimes, when an HIV medicine is causing a rash, it may be necessary to switch to another HIV medicine.

If you are taking HIV medicines, 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, life-threatening condition.

A rash can be a sign of a hypersensitivity reaction. A hypersensitivity reaction 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 be life-threatening and requires immediate medical attention.

Stevens-Johnson syndrome (SJS) is a rare but life-threatening hypersensitivity reaction reported with the use of some HIV medicines. People taking HIV medicines need to know about this condition. It rarely occurs, but when it does, it can cause death.

Symptoms of SJS include fever, flu-like symptoms, rash, and painful blisters that may spread throughout the body.

If you have symptoms of SJS, get medical help immediately. SJS can be life-threatening.

From the Department of Health and Human Services:

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

From MedlinePlus:

• Drug Allergies

From the National Institutes of Health: National Center for Advancing Translational Sciences:

• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

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