Antiretroviral HIV Drugs: Side Effects and Adherence

Medically reviewed by Alan Carter, PharmD on June 16, 2016Written by Stephanie Watson on October 10, 2014

Sticking to your treatment plan

The main treatment for HIV is a class of drugs called antiretrovirals. These drugs don’t cure HIV, but they can reduce the amount of virus in your body. This can keep the virus from destroying your immune system.

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

Sticking to your treatment plan isn’t always easy. These drugs can cause side effects that 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. This could cause the HIV to become resistant to the drugs you’re taking. If that happens, you’re left with fewer options to treat your HIV.

Antiretroviral drug side effects and how to treat them

HIV drugs have improved over the years, and serious side effects are less likely than they used to be. However, HIV drugs can still cause side effects. Some are mild. Others are more severe or even life-threatening. A side effect can also get worse the longer you take the drug.

It’s possible for other medications you take to interact with your HIV drugs. Other conditions you have can also make the side effects from HIV drugs worse. For these reasons, when you start taking any new drug, you should tell your doctor and pharmacist about all the other medications, supplements, and herbs you take.

If you have any new or unusual side effects, you should call your doctor. You should do this even if you’ve been on the medication for a long time. It can take months or years for you to start reacting to a drug.

For serious side effects, your doctor might make sure that it’s your medication and not another factor that’s causing your symptoms. If the drug is to blame, your doctor might switch you to another antiretroviral drug. This isn’t as easy as it sounds. Your doctor needs to be sure that the new treatment will still work 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, your doctor might suggest that you change the way you take it. For instance, they may tell you to take it with food instead of on an empty stomach or at night instead of in the morning. In some cases, it may be easier to treat the side effect to make it more manageable.

Here are some of the most common side effects from antiretroviral treatment and ways you can try to manage them.

Appetite loss

Drugs that cause it: Abacavir (Ziagen)

What might help:

  • Eat several small meals per day instead of three big ones.
  • Drink smoothies or take nutritional supplements to make sure you get enough vitamins and minerals.
  • Ask your doctor about prescribing you an appetite stimulant.

Lipodystrophy (changes in the distribution of body fat)

Drugs that cause it: combinations of drugs from the nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitor classes, other HIV drugs

NRTIs include:

Protease inhibitors include:

Lipodystrophy is a condition that causes you to lose or gain fat in certain body areas. This side effect may not bother you. But we understand that this side effect may make some people self conscious or anxious. For these people, there are some options.

What might help:

  • Exercise can help you lose body fat from your whole body, including the areas where fat has built up.
  • An injectable drug called tesamorelin (Egrifta) may help reduce excess belly fat in people who take HIV drugs. However, when you stop taking tesamorelin, your belly fat is likely to come back.
  • Liposuction can remove fat in areas where it has collected.
  • Ask your doctor about getting injections of polylactic acid (New Fill, Sculptra) in your face if you’ve lost weight there.

Read more: Options for managing lipodystrophy »


Drugs that cause it:

What might help:

  • Eat fewer greasy, fatty, spicy, and dairy foods, including fried foods and products that contain milk.
  • Eat fewer foods that are high in insoluble fiber, such as raw vegetables, whole grain cereals, and nuts.
  • Ask your doctor if you should take over-the-counter anti-diarrheal medications, such as loperamide (Imodium) or diphenoxylate/atropine (Lomotil).


Fatigue is a side effect of HIV drug treatment, but it is also a symptom of HIV.

Drugs that cause it:

What might help:

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

Higher than normal levels of cholesterol and triglycerides (lipids or blood fats)

Drugs that cause it:

What might help:

  • Do not smoke.
  • Exercise more.
  • Reduce the amount of fat in your diet. Talk with a nutritionist about the safest way to do this.
  • Eat fish and other foods that are high in omega-3 fatty acids. These include walnuts, flaxseeds, and canola oil.
  • Have blood tests to check your cholesterol and triglyceride levels as often as your doctor suggests.
  • Take statins or other medications that lower cholesterol if your doctor suggests it.

Mood changes, depression, and anxiety

Drugs that cause it: Efavirenz (Sustiva)

What might help:

  • Talk to your doctor about changing the timing of when you take your medication.
  • Avoid alcohol and illegal drugs.
  • Ask your doctor about counseling or antidepressant medications.

Nausea and vomiting

Drugs that cause it: Almost all HIV drugs

What might help:

  • Eat smaller portions several times during the day instead of three big meals.
  • Eat bland foods, such as plain rice and crackers.
  • Avoid fatty, spicy foods.
  • Eat your meals cold instead of hot.
  • Ask your doctor about anti-emetic medications to control nausea.


Drugs that cause it:

What might help:

  • Moisturize your skin with lotion each day.
  • Use cool or lukewarm water rather than hot water in your showers and baths.
  • Use mild, non-irritating soaps and laundry detergents.
  • Wear fabrics that breathe, such as cotton.
  • Ask your doctor if you can take an antihistamine medication.

Trouble sleeping

Drugs that cause it:

What might help:

  • Exercise regularly.
  • Stick to a set sleep schedule and avoid taking naps so you’re tired at night.
  • 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 medications if the problem continues.

Other side effects

Other side effects from antiretroviral drugs include:

  • hypersensitivity or allergic reactions, with symptoms can such as:
    • fever
    • nausea
    • vomiting
  • bleeding
  • bone loss
  • heart disease
  • high blood sugar and diabetes
  • lactic acidosis (high lactic acid levels in your blood)
  • kidney, liver, or pancreas damage
  • numbness, burning, or pain in your hands or feet due to nerve problems

Work with your healthcare team

Taking your HIV drugs exactly as prescribed is important for them to work. If you have side effects, don’t stop taking your medication. Instead, talk to your healthcare team. They may suggest ways you can ease your side effects, or they may tweak your treatment plan.

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

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