HIV Antiviral Drugs - What are the common side effects?
Side effects of HIV antiviral drugs depend on the drugs and drug combinations that are chosen for treatment.
According to the U.S. Department of Health and Human Services, some of the more common side effects for many antiretroviral (ARV) drugs include:
Side effects can be different for men vs. women, and are also affected by the use of other drugs and other conditions you may have, as well as genetic factors.
HIV treatment regimens and side effects
There are four main types of ARV drugs recommended for initial treatment based on how they attack the HIV virus. The types are:
- Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Protease inhibitors (PIs)
- Integrase strand transfer inhibitors (INSTIs)
All of these medications may cause side effects, but the side effects are not very predictable. Some people experience more side effects than others, and some people experience no side effects. Newer ARV drugs have fewer side effects. Side effects may also be different for people taking the same drugs. In many cases, side effects get better over time. In some cases, side effects develop and worsen over time.
Current guidelines for adults and adolescents with HIV recommend starting treatment with two NRTIs, along with one INSTI, NNRTI, or a protease inhibitor. Drugs approved for use in these regimens have some common side effects:
- NRTIs, such as abacavir, lamivudine, tenofovir, alafenamide and emtricitabine. Common side effects of these drugs are muscle aches, tingling and numbness (neuropathy), loss of fat (lipodystrophy) in face and limbs and lactic acidosis (which may cause nausea, vomiting and weakness).
- INSTIs, such as dolutegravir and bictegravir. Common side effects include weight gain, nausea, diarrhea, headache, fatigue, anxiety, dizziness, insomnia and mood swings.
- NNRTIs, such as nevirapine, rilpivirine and etravirine. Common side effects may include fever, rash, mood changes and insomnia.
- Protease inhibitors, such as ritonavir, nelfinavir, lopinavir, amprenavir, atazanavir and darunavir. Common side effects may include diarrhea, nausea and skin rash.
It is important to never stop ARV drugs due to side effects. Stopping ARV therapy or skipping days of ARV can lead to drug resistance, making HIV harder to control.
Your HIV health care providers will suggest ways to manage side effects, prescribe medications to help relieve side effects, and in some cases, recommend changes to another ARV drug or regimen.
Tips for managing side effects at home
In most cases, minor side effects can be managed with these tips:
- For a headache, make sure to drink enough fluids. Rest in a darkened room and take an over-the-counter (OTC) pain reliever.
- For fatigue, try to get some low-impact exercise on most days. This will give you more energy and help you sleep better.
- If you have trouble sleeping, limit all fluids 2 hours before bed. Avoid caffeinated beverages in the afternoon and evening. Avoid heavy meals in the evening. Keep your bedroom quiet, dark and comfortable.
- For nausea, eat smaller and more frequent meals. Avoid heavy, greasy, spicy and acidic foods. Try adding some ginger to your diet, such as ginger ale or ginger tea. If you have poor appetite, supplement your diet with a protein shake.
- For diarrhea, add fiber to your diet from bananas, white rice, applesauce and white bread or toast. Avoid milk and dairy products. Avoid high-fiber foods like whole grains and brown rice and foods that are high in sugar and fat.
- For skin rashes, drink plenty of fluids. Avoid dry skin from long hot showers, strong soaps and skin products with alcohol. Use a moisturizing skin lotion. Protect your skin from the sun with sunscreen.
- For dry mouth, swish some warm salted water throughout the day. You can also try some crushed ice. Use a sugarless candy or lozenge to keep your mouth moist. Try licorice tea or an OTC mouth moisturizing product.
If you have difficulty managing side effects at home, do not stop taking your ARV medications. Call your health care provider.
Living with HIV
Managing and avoiding HIV treatment side effects is an important part of taking your ARV drugs every day. HIV is no longer considered a fatal disease in people who stay on their medications. However, you need to remember that ARV therapy does not cure HIV. Even when your viral load is undetectable, there is still a small amount of HIV resting inside some cells of your body. If you skip your daily dose of ARV drugs or you stop because you feel fine, your viral load will go up, and you could get sick or spread HIV to a partner.
HIV is an infection caused by a type of virus called a retrovirus. As soon as a person is diagnosed with HIV, antiretroviral (ARV) drugs are started to reduce the amount of virus in the blood, called the viral load. Daily ARV drugs can prevent illness from HIV as well as the spread of HIV to others once the viral load becomes undetectable.
Untreated HIV weakens the body’s defense system, called the immune system. Before modern ARV drugs became available, life-threatening infections or cancers could be fatal for most people with HIV/AIDS. There are now more than 30 ARV drugs that are approved for HIV. Current guidelines say to start ARV drugs as soon as possible after diagnosis.
- U.S. Department of Health and Human Services (HHS). HIV Treatment Overview. March 29, 2019. Available at: https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/hiv-treatment-overview. [Accessed January 6, 2022].
- U.S. Department of Health and Human Services (HHS). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. June 3, 2021. Available at: https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/what-start-initial-combination-regimens-antiretroviral-naive. [Accessed January 6, 2022].
- U.S. Department of Health and Human Services (HHS). Side Effects of HIV Medicines. August 23, 2021. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-medicines-and-side-effects. [Accessed January 6, 2022].
- StatPearls. Reverse Transcriptase Inhibitors. January 7, 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551504/#_NBK551504_pubdet_. [Accessed January 6, 2022].
- Kolakowska A, Maresca AF, Collins IJ, et al. Update on Adverse Effects of HIV Integrase Inhibitors. Curr Treat Options Infect Dis. 11, 372–387 (2019). https://doi.org/10.1007/s40506-019-00203-7.
- Lv Z, Chu Y, Wang Y. HIV protease inhibitors: a review of molecular selectivity and toxicity. HIV AIDS (Auckl). 2015;7:95-104. https://doi.org/10.2147/HIV.S79956.
- U.S. Department of Veterans Affairs. Tips for Common Side Effects. September 11, 2020. Available at: https://www.hiv.va.gov/patient/side-effects-guide/. [Accessed January 6, 2022].
- National Institute of Allergy and Infectious Disease (NIAID). 10 Things to Know About Viral Suppression. June 12, 2020. Available at: https://www.niaid.nih.gov/diseases-conditions/10-things-know-about-hiv-suppression. [Accessed January 6, 2022].
- U.S. National Library of Medicine MedlinePlus. Lactic acidosis. October 11, 2020. Available at: https://medlineplus.gov/ency/article/000391.htm. [Accessed January 6, 2022].
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