Remember that some side effects are more common than others, and each person may react differently to the same medicine. For this reason, a drug regimen can’t be based solely on possible side effects. While taking medications, discuss any physical changes or new symptoms with your doctor and pharmacist. Some side effects can be managed or controlled, while others require intervention or medication changes. Although not always stated here, some side effects may be rare. See drug page or package insert for more information.
There are both benefits and potential side effects associated with HIV medications, known as antiretroviral therapy (ART). Benefits of ART include restoration of the immune system and reduction in risk of HIV transmission, especially if the viral load is undetectable (less than 50 copies/mL). Safer sex methods should be practiced, and additional information regarding HIV transmission can be found at aidsinfo.nih.gov. One potential side effect of ART is known as immune reconstitution inflammatory syndrome (IRIS), which may occur as the immune system regains strength following initiation of therapy. Symptoms of illnesses such as shingles and tuberculosis should be reported to a health care provider immediately.
POTENTIAL DRUG CLASS SIDE EFFECTS: Rare but potentially serious side effects with all NRTIs are enlarged, fatty liver and lactic acidosis (accumulation of lactate in the blood and abnormal acid-base balance). Lactic acidosis may cause persistent fatigue, abdominal pain or distension, nausea/vomiting, and difficulty breathing. These conditions are seen even less with newer and now commonly used NRTIs (specifically Epzicom and Truvada).
Combivir
lamivudine / zidovudine—fixed-dose combination
See Epivir and Retrovir.
Emtriva
emtricitabine, or FTC
A very tolerable drug, but side effects may include headache, diarrhea, and nausea. A flare-up of existing hepatitis B may occur when stopping Emtriva. Darkening of the skin on the palms and the soles of the feet has also been reported.
Epivir
lamivudine, or 3TC
A very tolerable drug, but side effects may include headache, nausea, vomiting, diarrhea, fever, fatigue, hair loss, insomnia, malaise (general ill feeling), nasal symptoms, and cough. A flare-up of existing hepatitis B may occur when stopping Epivir.
Epzicom
abacavir / lamivudine—fixed-dose combination
See Ziagen and Epivir.
Retrovir
zidovudine, AZT, or ZDV
Headaches, fever, chills, muscle soreness and/or damage, fatigue, nausea, lipoatrophy (fat loss in the arms, legs, face, and/or buttocks—sometimes called “AZT butt”), blue/black nail discoloration, anemia (low red blood cell count), and neutropenia (low white blood cell count).
Trizivir
abacavir / lamivudine / zidovudine—fixed-dose combination
See Ziagen, Epivir, and Retrovir.
Truvada
emtricitabine / tenofovir
See Emtriva and Viread. Abdominal distension/pain.
Videx EC
didanosine, or ddI
Peripheral neuropathy (tingling, burning, numbness or pain in the hands or feet), upset stomach, diarrhea, vomiting, rash, pruritis (itchiness), and headache. Pancreatitis and lactic acidosis. Eye changes and optic neuritis. Increased uric acid levels, alkaline phosphatase, and amylase levels. Body fat redistribution, insulin resistance, and diabetes. Non-cirrhotic portal hypertension.
Viread
tenofovir, or TDF
A very tolerable drug, but side effects may include headache, diarrhea, pain, depression, nausea, weakness, and gas. Kidney toxicities and decreased bone mineral density. A flare-up of existing hepatitis B may occur when stopping tenofovir.
Zerit
stavudine, or d4T
Headache, diarrhea, nausea, vomiting, rash, peripheral neuropathy (tingling, burning, numbness or pain in the hands or feet), pancreatitis, lipoatrophy (fat loss in the arms, legs, face, and/or buttocks), mitochondrial toxicities (a variety of symptoms caused by cell damage), and elevated cholesterol levels.
Ziagen
abacavir, or ABC
Hypersensitivity reaction, nausea, vomiting, diarrhea, fatigue, headache, fever, rash, trouble sleeping, unusual dreams, anorexia (loss of appetite), and potential for increased cardiovascular event, especially in patients with risk factors.
POTENTIAL DRUG CLASS SIDE EFFECTS: Common with NNRTIs is rash, and rarely, severe rash which may require immediate medical attention.
Edurant
rilpivirine, or RPV
Insomnia, headache, rash, and depressive disorders. Liver problems may occur. Nephrotic syndrome (kidney disorder, which may not be related to rilpivirine).
Intelence
etravirine, or ETR
Rash and increased cholesterol. Skin or hypersensitivity reactions. Rarely, peripheral neuropathy.
Rescriptor
delavirdine, or DLV
Increased liver enzyme levels and itchy skin or rash.
Sustiva
efavirenz, or EFV
Central nervous system (CNS) and psychiatric symptoms. Rash, nausea, vomiting, diarrhea, fever, and increases in triglycerides, cholesterol, and liver enzyme levels. False positive tests for marijuana. Birth defects.
Viramune XR
nevirapine, or NVP
Headache, nausea, vomiting, fever, rash, Stevens-Johnson syndrome, increased liver enzyme levels, liver damage, and drug-induced hepatitis.
POTENTIAL DRUG CLASS SIDE EFFECTS: The most common class side effects of protease inhibitors include gastrointestinal (GI) side effects such as nausea, vomiting, and diarrhea. These occur most frequently only at the beginning of therapy. Additional side effects seen with most PIs (except for unboosted Reyataz) include increased levels of total cholesterol, triglycerides, and blood sugar, which may be associated with an increased risk of heart disease. Other possible side effects include lipodystrophy (body fat changes), liver toxicity, osteoporosis, increased bleeding in hemophiliacs, and rash (especially with sulfa allergies). Medical attention needed for severe rash.
Aptivus
tipranavir, or TPV
(must be taken with Norvir)
Use with caution in patients allergic to sulfa drugs. Most common are mild diarrhea, nausea, vomiting, abdominal pain, and fatigue. Other side effects may include headache, fever, dry mouth, dizziness, rash (including sensitivity to the sun), liver abnormalities, and bleeding in the brain. May also increase blood sugar, cholesterol, and triglycerides.
Also see Norvir.
Crixivan
indinavir sulfate, or IDV
Kidney stones, itchy/dry skin, ingrown toe nails, hair loss, headache, fatigue, weakness, malaise (general ill feeling), nausea, diarrhea, stomach pain, loss of appetite, yellowing of skin/eyes, changed skin color, dry mouth/sore throat, taste changes, painful urination, indigestion, joint pain, hives, liver toxicity, Stevens-Johnson syndrome, hemolytic anemia, diabetic ketoacidosis, increase in bilirubin, insulin resistance, diabetes, body fat changes, and increased cholesterol levels. Kidney stones and jaundice can be minimized or avoided by drinking at least 1.5 liters of water per day.
Invirase
saquinavir, or SQV
(must be taken with Norvir)
Most common side effects are diarrhea, abdominal discomfort, vomiting, and nausea. Other side effects may include lipodystrophy and potential heart problems when given with certain other medications. Also see Norvir.
Kaletra
lopinavir / ritonavir, or LPV / r
Diarrhea is the most common side effect. Other side effects may include elevated cholesterol and triglycerides (fat in the blood), insulin resistance, rash, nausea, vomiting, stomach pain, headache, muscle weakness, and lipodystrophy. Also see Norvir.
Lexiva
fosamprenavir calcium, or FPV
Use with caution in patients allergic to sulfa drugs. Nausea, rash, diarrhea, headache, vomiting, and elevated liver enzymes.
Norvir
ritonavir, or RTV
Weakness; stomach pain; nausea; diarrhea; vomiting; tingling/numbness around the mouth, hands, or feet; loss of appetite; taste disturbance; weight loss; headache; dizziness; pancreatitis; alcohol intolerance; increased liver enzyme levels; hepatitis (liver inflammation); jaundice (yellowing of skin or eyes); increased muscle enzyme (CPK); and uric acid.
Prezista
darunavir, or DRV
(must be taken with Norvir)
Use with caution in patients allergic to sulfa drugs. Side effects may include: diarrhea, nausea, headache, rash, vomiting, and abdominal pain. Also see Norvir.
Reyataz
atazanavir sulfate, or ATV
Dizziness, nausea, possible jaundice (yellowing of the skin or eyes), rash, kidney stones, gall stones, abnormal heart rhythm, and elevated liver enzymes
Viracept
nelfinavir, or NFV
Diarrhea, stomach discomfort, nausea, gas, weakness, and rash.
POTENTIAL DRUG CLASS SIDE EFFECTS: Because boosted protease inhibitors contain two medicines from different drug classes, you should look up each drug contained in the pill.
EvoTaz
atazanavir / cobicistat
See Reyataz and Tybost.
Prezcobix
darunavir / cobicistat
See Prezista and Tybost.
POTENTIAL DRUG CLASS SIDE EFFECTS: No class side effects known to date.
Isentress
raltegravir, or RAL
Very tolerable and infrequent side effects, which may include diarrhea, insomnia, nausea, headache, dizziness, and fatigue. Rare side effects may include abdominal pain; vomiting; weakness; mild to moderate rash; anxiety; anemia (low red blood cells); neutropenia (low white blood cells); lipodystrophy; elevated levels of creatine kinase; increases in ALT, AST, and total bilirubin; hypersensitivity reactions; and cerebellar ataxia. Chewable tablets contain phenylalanine.
Tivicay
dolutegravir, or DTG
A very tolerable drug, but side effects may include insomnia, headache, fatigue, and hypersensitivity.
Vitekta
elvitegravir, or EVG
Most common side effects are nausea, diarrhea, headache, and fatigue. Elevated liver enzymes.
POTENTIAL DRUG CLASS SIDE EFFECTS: No class side effects known to date.
Fuzeon (FUSION INHIBITOR)
enfuvirtide, T-20, or ENF
Injection site reactions (ISRs) such as itching, pain/discomfort, or redness at site of injection; pneumonia; diarrhea; nausea; and fatigue. Hypersensitivity possible.
Selzentry (CCR5 ANTAGONIST)
maraviroc, or MVC
The most common side effects include cough, fever, cold, rash, muscle and joint pain, stomach pain, dizziness, and trouble sleeping. Other side effects may include allergic reactions, liver toxicity, and heart problems in those with a history of heart disease. Rarely, dizziness or fainting when standing up due to low blood pressure. Possible increased risk of infections and cancer.
POTENTIAL DRUG CLASS SIDE EFFECTS: Because STRs contain a combination of medications from different drug classes, you should look up each drug contained in the pill.
Atripla
efavirenz / emtricitabine / tenofovir
See Sustiva and Truvada (Emtriva and Viread). Diarrhea, nausea, fatigue, headache, dizziness, depression, insomnia, abnormal dreams, rash, and false positive test for marijuana. Risk of birth defects.
Complera
rilpivirine / emtricitabine / tenofovir
See Edurant and Truvada (Emtriva and Viread). Insomnia, headache, depressive disorders, and a slight increase in liver enzymes.
Stribild
elvitegravir / cobicistat / emtricitabine / tenofovir
See Vitekta, Tybost, and Truvada (Emtiva and Viread). Nausea, diarrhea, headache, abnormal dreams, fatigue, increases in total cholesterol, bone problems, elevated liver function tests, and changes in kidney function tests.
Triumeq
dolutegravir / lamivudine / abacavir
See Tivicay, Epivir, and Ziagen. Most common side effects are insomnia, headache, and fatigue. A small increase in serum creatinine may be seen. Hypersensitivity and possibility of heart problems.
POTENTIAL DRUG CLASS SIDE EFFECTS: No class side effects known to date.
Tybost
cobicistat, or COBI
Side effects seen in clinical studies include diarrhea, nausea, increases in cholesterol and triglycerides, red blood cells in the urine, and modest increase in serum creatinine (SCr) and decreased estimated creatinine clearance (CrCl).