Side effects from antiretroviral HIV drugs can include appetite loss, diarrhea, fatigue, and mood changes. However, not sticking to a treatment plan can cause the virus to become resistant to drugs and harder to treat.

The main treatment for HIV is a class of drugs called antiretrovirals. These drugs do not cure HIV, but they can reduce the amount of virus in the body of someone living with HIV. This keeps the immune system strong enough to fight off disease, and if a person living with HIV maintains an undetectable viral load through their treatment, they have zero risk of transmitting HIV to their sexual partners.

Currently, more than 40 antiretroviral drugs or drug combinations are approved to treat HIV. Most people who treat their HIV will take two or more of these drugs each day long term.

Adherence to a treatment plan

Antiretroviral drugs must be taken at the right time and in the right way for them to work properly. Taking these medications the way a healthcare professional has prescribed is called adherence.

Sticking to a treatment plan isn’t always easy. Antiretroviral drugs can cause side effects that can be severe enough that some people stop taking them.

But if a person with HIV skips doses of these drugs, the virus can start copying itself in their body again. This could cause HIV to become resistant to the drugs. If that happens, the drug will no longer work, limiting options the person has to treat their HIV.

Read on to learn more about antiretroviral drug side effects, and how to manage them and stick to a treatment plan.

Adherence

Adherence means sticking to a treatment plan, and it’s very important. If a person with HIV skips doses or stops taking their treatment, the virus could become resistant to the drugs. This may make it difficult or impossible to treat their HIV.

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, while others are more severe or even life threatening. A side effect can also get worse the longer a drug is taken.

It’s also possible for other medications to interact with HIV drugs, causing side effects. Other health conditions can also make the side effects from HIV drugs worse. For these reasons, when starting any new drug, people with HIV should talk with a healthcare professional and pharmacist about all the other medications, supplements, or herbs they’re taking.

In addition, if any new or unusual side effects occur, people with HIV should contact a healthcare professional. They should do this even if they’ve been on the medication for a long time. It can take months or years to start reacting to a drug.

For serious side effects, a healthcare professional might make sure that it’s the medication and not another factor that’s causing the symptoms. If the drug is to blame, they might switch treatment to another antiretroviral drug. However, switching treatments isn’t easy. They need 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 the body gets used to the drug. If not, a healthcare professional might suggest changing the way the drug is taken. For instance, they may recommend taking 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 effects to make them more manageable.

Here are some of the more common side effects from antiretroviral drugs and tips for managing them.

Loss of appetite happens when you have a decreased desire to eat.

Examples of drugs that may cause it:

  • abacavir (Ziagen)
  • zidovudine

What might help:

  • Eat several small meals per day instead of three large ones.
  • Drink smoothies or take nutritional supplements to make sure the body is getting enough vitamins and minerals.
  • Ask a healthcare professional about taking an appetite stimulant.

Some medications can also cause weight gain.

Usually, weight gain is a good sign of the antiretroviral medication starting to work, but it’s also possible to see adverse effects from the weight gain, including a high risk of cardiovascular disease or diabetes. This is especially true for people had overweight or obesity before starting the medication.

Examples of drugs that may cause it:

  • dolutegravir

What might help:

  • Regular physical activity can help maintain weight.
  • Add fruits, vegetables, and whole grains to your eating plan to help reduce the risk of diabetes or cardiovascular disease.
  • Your doctor may suggest trying another medication.

Lipodystrophy is a condition that causes people to lose or gain fat in certain body areas. This may make some people feel self-conscious or anxious.

Examples of drugs that may cause it: Combinations of drugs from the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) and protease inhibitor classes.

NRTIs include:

  • atazanavir
  • darunavir
  • nelfinavir
  • ritonavir
  • saquinavir

What might help:

  • Physical activity, such as regular exercise, can help reduce body fat from the 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 antiretroviral HIV drugs. However, when people stop taking tesamorelin, belly fat is likely to come back.
  • Liposuction can remove fat in areas where it has collected.
  • If weight loss occurs in the face, a healthcare professional can provide information about injections of polylactic acid (New Fill, Sculptra).
  • A healthcare professional can prescribe metformin for people with diabetes and HIV. TThis diabetes drug can help reduce fat redistribution related to lipodystrophy.
  • GLP-1 receptor agonists are becoming an option for treatment of weight gain and lipodystrophy in people who take HIV medications, but studies are still ongoing.

Diarrhea consists of loose, watery stools that happen multiple times per day. It typically also causes urgency to have a bowel movement.

Examples of drugs that may 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 a healthcare professional about the benefits of taking over-the-counter antidiarrheal medications, such as loperamide (Imodium).

Fatigue is a side effect of HIV drug treatment, but it’s also a symptom of HIV. It refers to a lack of energy and a general feeling of tiredness.

Examples of drugs that may cause it:

  • zidovudine
  • efavirenz

What might help:

  • Eat nutritious foods to increase energy.
  • Stay physically active as often as you feel able to.
  • Avoid smoking and drinking alcohol if applicable.
  • Stick to a set sleep schedule and avoid taking naps.

Stay safe

People with HIV should check with a healthcare professional before trying any of these suggestions. A healthcare professional will determine if it’s a safe option.

Having high levels of cholesterol and triglycerides may not cause any symptoms.

Examples of drugs that may cause it:

  • zidovudine
  • efavirenz
  • lopinavir/ritonavir
  • tipranavir/ritonavir
  • atazanavir/cobicistat
  • darunavir/cobicistat
  • nelfinavir
  • ritonavir
  • abacavir
  • tenofovir

What might help:

  • If you smoke, consider quitting.
  • Increase physical activity, such as exercising, if you feel up to it.
  • Reduce the amount of fat in your diet if possible. Talk with a dietitian 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 cholesterol and triglyceride levels as often as a healthcare team suggests.
  • Take statins or other medications that lower cholesterol if a healthcare professional prescribes them.

Mood changes, including depression and anxiety, can be a side effect of HIV drug treatment. But mood changes can also be a symptom of HIV.

Examples of drugs that may cause it:

  • efavirenz (Sustiva)
  • rilpivirine (Edurant, Odefsey, Complera)
  • dolutegravir

What might help:

Nausea can cause vomiting but doesn’t always result in throwing up.

Examples of drugs that may cause it: almost all HIV drugs

What might help:

  • Eat smaller portions throughout the day instead of three big meals.
  • Eat foods that are easy on the stomach like plain rice and crackers.
  • Avoid fatty, spicy foods.
  • Eat meals cold instead of hot.
  • Ask a healthcare professional about antiemetic medications to control nausea.

Rash is a side effect of almost every HIV medication. But a severe rash can also be a symptom of an allergic reaction or another serious condition. Call 911 or your local emergency services or go to the emergency room if you have a rash along with any of the following:

  • trouble breathing or swallowing
  • fever
  • blisters, especially around the mouth, nose, and eyes
  • a rash that starts quickly and spreads

Examples of drugs that may cause rash:

  • protease inhibitors
  • emtricitabine
  • raltegravir
  • elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate
  • non-NRTIs, including:
    • etravirine
    • rilpivirine
    • efavirenz
    • nevirapine

What might help:

  • Moisturize the skin with unscented lotion each day.
  • Use cool or lukewarm water rather than hot water in showers and baths.
  • Use mild, nonirritating soaps and laundry detergents.
  • Wear fabrics that breathe, such as cotton.
  • Ask a healthcare professional about taking an antihistamine medication.

Waking up still fatigued, finding it hard to fall asleep, or waking up during the night are all under the umbrella of sleep troubles.

Examples of drugs that may cause trouble sleeping:

  • efavirenz
  • emtricitabine
  • rilpivirine
  • elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate
  • dolutegravir

What might help:

  • Regular physical activity, such as exercising if you can.
  • Stick to a set sleep schedule and avoid taking naps.
  • Make sure the 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 with a healthcare professional about treatment for insomnia if the problem continues.

Other side effects from antiretroviral drugs can include:

Taking HIV drugs exactly as prescribed is important for them to work properly. If side effects occur, do not stop taking the medication. Instead, talk with the healthcare team. They may suggest ways to ease the side effects, or they may tweak the treatment plan.

It might take some time for people with HIV to find the right drug regimen. With careful monitoring and follow-up, healthcare professionals will find the antiretroviral drug regimen that works well with the fewest side effects.