Antiretroviral HIV Drugs: Side Effects & Adherence
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Antiretroviral HIV Drugs: Side Effects & Adherence

The Importance of Sticking to the Plan

The main treatment for HIV is a class of drugs called antiretrovirals. These drugs don’t cure HIV, but they can dramatically reduce the amount of virus in the body so it can’t destroy the immune system.

Today, more than 20 antiretroviral drugs are approved to treat HIV. Most people will take two or more of these drugs every day for the rest of their lives. You have to take antiretroviral drugs at the right time and in the right way in order for them to work. Taking your medicines the way your doctor prescribed them is called “adherence.”

Why is adherence so important? If you skip doses or stop taking ART for any reason, HIV could become resistant to the drugs.

The antiretroviral treatment regimen isn’t easy. These drugs can cause side effects, which can be severe enough to make some people stop taking them. If you skip doses, the virus can start copying itself in your body again. It could become resistant to the medicine you are taking, leaving you with fewer effective options to treat your HIV. That’s why it’s so important to work closely with your doctor to find the best drug for you, and to address side effects right away if you experience them.

Antiretroviral Drug Side Effects — And How to Treat Them

Most medicines you take can cause side effects. HIV drugs are no exception. Some of the side effects they cause are mild. Others are more severe, or even life threatening. A side effect can get worse the longer you keep taking the drug.

It’s also possible for other medications you take to interact with your HIV medications. Additionally, other conditions you have may amplify the side effects from these drugs (for example, viral hepatitis can worsen effects on the liver from HIV drugs). That’s why, when you start taking any new drug, you should tell your doctor and pharmacist about all the other medicines you take — even drugs you buy over the counter without a prescription.

Here are some of the most common side effects from antiretroviral treatment, and ways your doctor might recommend to manage them:

Appetite Loss

Antiretroviral drugs that cause it: Abacavir (Ziagen)

What you might do to help:

  • Eat several small meals a day, instead of three big ones.
  • Drink nutritional supplements or smoothies to make sure you get enough vitamins and minerals.
  • Take an appetite stimulant.

Changes in the Distribution of Body Fat (Lipodystrophy)

Antiretroviral drugs that cause it: combinations of drugs from the NRTI and protease inhibitor classes (although some people with HIV who aren’t on these drugs also have this side effect)

What you might do to help:

  • Exercise to lose weight in areas where you’ve gained fat, such as in the stomach.
  • Get injections of polylactic acid (New Fill, Sculptra) in your face if you’ve lost weight there.
  • Have liposuction to remove fat in other areas where it has collected.
  • Ask your doctor about trying a drug called tesamorelin (Egrifta), which reduces excess belly fat in people who take HIV medicine.


Antiretroviral drugs that cause it: Protease inhibitors and other medicines

What you might do to help:

  • Eat fewer greasy, fatty, spicy, and dairy foods.
  • Eat less insoluble fiber (raw vegetables, whole grain cereal, nuts).
  • Take over-the-counter anti-diarrheal medicines such as loperamide (Imodium) or diphenoxylate and atropine (Lomotil).


Antiretroviral drugs that cause it: Many different drugs

What you might do to help:

  • Eat healthy foods to give you more energy.
  • Exercise as often as you can.
  • Avoid drinking alcohol and smoking.

Higher than Normal Levels of Cholesterol and Triglycerides (Lipids) in the Blood

Antiretroviral drugs that cause it: Protease inhibitors and other medicines

What you might do to help:

  • Stop smoking.
  • Exercise more.
  • Reduce the amount of fat in your diet (talk with a dietitian about the safest way to do this).
  • Eat fish and other foods that are high in omega-3 fatty acids.
  • Have blood tests at your doctor’s office to check your cholesterol and triglyceride levels.
  • Take statins or other lipid-lowering medicines if you need them.

Mood Changes, Depression, Anxiety

Antiretroviral drugs that cause it: Efavirenz (Sustiva)

What you might do to help:

  • Change the timing of your medicine dose (talk to your doctor first).
  • Avoid alcohol and recreational drugs.
  • Try talk therapy or antidepressant medicines.

Nausea and Vomiting

Antiretroviral drugs that cause it: Almost all of them

What you might do to help:

  • Eat smaller portions several times during the day, instead of three big meals.
  • Eat bland foods like plain rice and crackers.
  • Avoid fatty, spicy foods.
  • Serve your meals cold, instead of hot.
  • Take anti-emetic medicines to control nausea.


Antiretroviral drugs that cause it: Nevirapine and other drugs

What you might do to help:

  • Moisturize your skin by applying lotion daily and avoiding hot showers and baths.
  • Use mild, non-irritating soaps and laundry detergents.
  • Wear fabrics that breathe, like cotton.
  • Ask your doctor if you can take an antihistamine medicine.

Trouble sleeping

Antiretroviral drugs that cause it: Efavirenz (Sustiva) and other medicines

What you might do to help:

  • Exercise regularly.
  • Stick to a sleep schedule and avoid naps.
  • Make sure your bedroom is comfortable for sleep.
  • Relax before bedtime with a warm bath or other calming activity.
  • Avoid caffeine and other stimulants within a few hours of bedtime.
  • Talk to your doctor about sleep medicines if the problem continues.

Other side effects from antiretroviral drugs include:

  • abacavir hypersensitivity reaction (fever, nausea, vomiting, and other side effects from taking abacavir)
  • bleeding
  • bone loss
  • heart disease
  • high blood sugar and diabetes
  • high lactic acid levels in the blood (lactic acidosis)
  • kidney, liver, or pancreas damage
  • numbness, burning, or pain in the hands or feet caused by nerve problems

If You Have Side Effects

HIV drugs have improved over the years, and serious side effects are much less likely than they used to be. However, if you’re having any new or unusual side effect, call your doctor — even if you’ve been on the medicine for a long time. Sometimes it can take months or years for you to start reacting to a medicine.

For more serious side effects, your doctor might first check to make sure that your medicine, and not other factors, is causing your symptoms. If the medicine is to blame, the doctor might switch you to another antiretroviral drug. Yet this isn’t as easy as it sounds. Because HIV is such a serious infection, your doctor needs to be sure that the new treatment will still work to control the virus, and that it won’t cause even more severe side effects.

Milder side effects may go away as soon as your body gets used to the drug. If not, the doctor might suggest that you change the way you take the drug (for example, taking it with food instead of on an empty stomach, or at night instead of in the morning). Alternately, you might be able to treat the side effect to make it more manageable.

It might take some time to find just the right drug regimen. With some careful monitoring and follow-up, your doctor will eventually find the antiretroviral medicine that not only works but is also safe for you.

Sticking to Your Medicine Routine

Side effects aren’t the only issue with HIV treatment. You also need to remember when and how to take your pills.

To help you take your medicine as directed, get a pill organizer. Arrange all of the pills by dose. Set reminders in your phone or computer so you’ll remember when it’s time to take your medicine.

Work with your doctor to find a dosing routine that works best for you. Review it at each visit and make adjustments as needed so you get the most benefit possible from your treatment.

Read Video Transcript »

Dr.’s Whiteboard: Understanding HIV Treatments Treatments for HIV have come a long way since the virus was first discovered in 1983. While scientists are still working on a cure for HIV, there are several drug therapies that can help HIV patients live long and full lives. The most common and effective therapies used today are retroviral drugs, which work by specifically targeting the virus that’s infected a person’s cells. Current retroviral drugs cannot completely eliminate the HIV virus, but they can keep virus levels—called viral loads—to a manageable level and prevent HIV from progressing to AIDS. There are five classes of retroviral drugs, and each is designed to attack the living virus at different points in its lifespan. 1. Nucleoside/nucleotide reverse transcriptase inhibitors, or NRTIs 2. Non-nucleoside reverse transcriptase inhibitors, or NNRTIs 3. Protease inhibitors 4. Entry or fusion inhibitors 5. Integrase inhibitors Many of these drugs stop or interrupt the virus from replicating and creating new copies of itself. Other drugs stop HIV from spreading in the body by blocking the virus from docking on, and infecting, healthy cells. Because many of these drugs work against the HIV virus differently, they are often combined in a “cocktail” form to prevent the virus from developing resistance and rendering treatment ineffective. Early HIV patients were subject to a handful of pills throughout the day, but now these drugs can be lumped together in a once-daily pill. This type of treatment goes by many names, including combined antiretroviral therapy, cART, or highly active antiretroviral therapy, HAART. Taking only one pill a day makes adhering to treatment much easier for patients, and adherence is the most important thing a patient can to ensure their therapy is effective. While these drugs can help HIV from progressing, there are some side effects. The most common effects of retroviral drugs are nausea, vomiting, diarrhea, fatigue, weakness, and dizziness. Some patients may develop a rash as well. Your doctor may prescribe medicine or recommend certain lifestyle changes to help combat these effects. In rare cases, people undergoing HIV treatment may experience other side effects such as an imbalance of sugars and lipids in the blood, bone loss, or abnormal fat distribution in the belly, neck, arms, or face. Working closely with your doctor can help mitigate these potential side effects. There is no one-size-fits all treatment plan for HIV treatments, but talking to your doctor about you concerns such as side effects, resistance, and how to incorporate treatment into your daily life can help you find the best drug regimen to keep the HIV virus in check. For more, browse through the expensive information available here on Healthline or make an appointment with your doctor.

More Resources

Understanding HIV Treatments
Controlling HIV: Benefits of Single Tablet Regimen
The Best HIV/STD Health Blogs of the Year