Managing Side Effects of HIV Medications

Managing Side Eects of

HIV MEDICATIONS

Table of Contents

What are side eects?..........................................................................................1

Why do I need to know about side eects of HIV medications? ...................... 2

What questions should I ask when my doctor rst prescribes

an HIV medication? .............................................................................................2

Make sure you understand what the medication does and the best way

to take it ......................................................................................................................................2

Your doctor can also help you prepare for any side eﬀects .....................................3

Make sure you know how to get help 24 hours a day ................................................3

What should I do when I begin feeling a side eﬀect? .................................................3

Why does the package insert list so many side eects? ................................... 4

Are there tests that can tell if I’m going to have side eects

from a certain drug? ............................................................................................ 4

Common side eects with all HIV medications ................................................. 4

Diarrhea ...................................................................................................................................... 5

Feeling tired (fatigue) .............................................................................................................5

Headache ...................................................................................................................................6

Liver problems ..........................................................................................................................6

Upset stomach (nausea), stomach pain, vomiting, poor appetite ........................7

Long-term loss of appetite and weight loss...................................................................8

Dietary supplements and natural therapies .....................................................8

Side eects of dierent classes of HIV drugs ....................................................9

Protease inhibitors ..................................................................................................................9

Fat problems (lipodystrophy) ..............................................................................................9

Metabolic problems ................................................................................................................ 9

Heart disease, heart attacks, stroke ...................................................................................9

Diabetes ................................................................................................................................... 10

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) .............................................. 10

Blood problems ..................................................................................................................... 10

Sleeping problems (insomnia) ......................................................................................... 11

Lactic acidosis ........................................................................................................................ 11

Nerve problems, tingling hands and feet (neuropathy) ......................................... 12

Thinning bones (osteoporosis, osteopenia)................................................................ 12

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) .................................. 13

Skin-related side eﬀects ..................................................................................................... 13

Fixed-Dose Combination Drugs ...................................................................................... 13

HIV combination drugs ...................................................................................................... 14

Fusion Inhibitors.................................................................................................................... 14

CCR5 Antagonists (Chemokine Co-receptor Antagonists) .................................... 14

Integrase Inhibitors .............................................................................................................. 15

Drug-specic side eects .................................................................................. 15

Abacavir: Severe allergic reaction ................................................................................... 15

Tenofovir (Viread), Truvada, Atripla, Stribild, Complera:

Chronic renal insuﬃciency (kidney failure) ................................................................. 15

Tipranavir (Aptivus): Hepatotoxicity (liver injury) ..................................................... 16

Efavirenz (Sustiva) and Atripla: Dizziness, confusion, sleeping problems ........16

Pancreatitis: didanosine (Videx), stavudine (Zerit); in children,

lamivudine (Epivir) ............................................................................................................... 16

Conclusion: Keeping your quality of life .......................................................... 17

What are side eects?

HIV medications help many people with HIV infection live longer, healthier lives.

Taking these medications on a regular basis lowers the amount of HIV (viral load)

in your body and protects your immune system. Lowering your viral load also

reduces your risk of transmitting HIV to others.

How often and how many medications you take to treat HIV infection has also

been simpliﬁed. Now, many medications are combined into a single pill you take

once a day, making HIV medications easier to take and treatment more

manageable as a whole.

As with most medications, HIV medications can cause side eﬀects. Side eﬀects are

symptoms or problems that may occur when you take a medication. Almost all

medications can cause side eﬀects, including HIV medications.

You may experience side eﬀects from your HIV medications at some point, es-

pecially when you begin taking the drug. But most side eﬀects can be managed

and will NOT cause you serious problems. Many people ﬁnd they can get into a

routine of taking their HIV medications as prescribed while keeping side eﬀects to

a minimum. If you work with your provider to manage any side eﬀects you

experience and keep taking your HIV medications, you have a better chance of

lowering the amount of HIV in your body and staying healthy longer. Once you

have a handle on side eﬀects, it will be easier to stick with your medication

schedule and keep your HIV viral load down.

Most side eﬀects you can see and feel, like headaches, upset stomach, a rash,

nervousness, or trouble concentrating. But other side eﬀects may not be so

obvious, like eﬀects on your liver or kidneys. Some side eﬀects are very common

and many people will experience them. Other side eﬀects are very rare. Your

age, body weight and size, gender and overall health can play a role in how you

experience side eﬀects.

Managing Side Eﬀects of HIV Medications | 1

Why do I need to know about side eects

of HIV medications?

Learning how to handle side eﬀects is an important part of taking HIV medications.

Dealing with side eﬀects will help with taking your HIV medications on schedule —

if you have a plan and stick with it, you’ll have a better chance of staying healthy. Try

to develop a plan for dealing with possible side eﬀects before you begin taking a

drug for the ﬁrst time.

When you start taking a medication, your doctor or pharmacist will explain any

possible side eﬀects and steps for dealing with them. If those steps don’t reduce

the side eﬀects and you continue to feel ill, call your doctor. Your doctor or

pharmacist will give you information on each medication telling you when you

should stop taking the drug and call for help.

What questions should I ask when my

doctor rst prescribes an HIV medication?

Make sure you understand what the medication does

and the best way to take it.

Ask your doctor:

• What is the name of the drug? Learn the drug’s brand name and its generic

(scientiﬁc) name. In this booklet, the generic name is listed ﬁrst and the brand

name follows in parentheses.

• What is the drug supposed to do?

• When do I take it? What is the best time of day to take the drug — for example,

before bed or ﬁrst thing in the morning?

• Should I take it with food or without food?

• Are there any foods or liquids I should avoid when taking the drug?

• Are there any other medications I should avoid when taking the drug?

Managing Side Eﬀects of HIV Medications | 2

Why does the package insert list so many

side eects?

The package insert is the printed information that usually comes with your

medication. By law, drug companies have to list all the possible side eﬀects, even if

they are very rare. The most common side eﬀects usually are listed ﬁrst, followed by

the less common ones. Package inserts list ALL possible side eﬀects, but that does

not mean you will experience them.

Are there tests that can tell if I’m going to have

side eects from a certain HIV medication?

Yes. Some patients have a genetic make-up that makes them more likely to have

side eﬀects from certain HIV medications. There are genetic tests for two HIV drugs:

Abacavir (Ziagen) is an NRTI that is also found in the combination drugs Trizivir and

Epzicom. Abacavir can cause hypersensitivity and a severe rash in some patients.

A genetic test is available that may be able to predict which patients will develop

this rash. The FDA recommends that all patients have this test before starting

abacavir treatment.

Atazanavir (Reyataz) is a protease inhibitor. Hyperbilirubinaemia (or jaundice) can

occur when this medication slows the liver’s ability to get rid of old red blood cells.

A genetic test is available that may be able to predict this reaction for some, but

not all patients.

Common side eects with all HIV medications

Some side eects can be caused by many dierent HIV medications.

These include:

• Diarrhea

• Feeling tired (fatigue)

• Headache

• Liver problems

• Upset stomach (nausea), stomach pain, vomiting, and poor appetite.

Most people ﬁnd these side eﬀects decrease over time or go away completely.

But other side eﬀects — like liver and kidney damage — you can’t feel, so your

doctor will test for them.

Your doctor can also help you prepare for any side eects.

Ask your doctor:

• What are the most common side eﬀects of this drug?

• Is there anything I can do to reduce the side eﬀects?

• Are any of the side eﬀects serious?

• Should I call you right away if I get a certain side eﬀect?

• Should I stop taking this drug or all my HIV medications right away

if I get a certain side eﬀect?

Make sure you know how to get help 24 hours a day.

Ask your doctor or healthcare provider:

• What should I do if I have a serious problem when your oﬃce is closed?

• Who should I call?

Many HIV clinics have a doctor, nurse, or other medical staﬀ person on call 24

hours a day. Keep emergency phone numbers and addresses (local rescue squad,

emergency room, etc.) handy in case you have to contact them when the clinic is

closed. Keep emergency contact numbers in a handy place, even if you never have

a problem with your HIV medications.

Give that information to a person you trust in case you cannot call for help yourself.

What should I do when I begin feeling a side eect?

Give your body a chance to adjust to the new medication. Remember, it is not

unusual to feel uncomfortable when you start any new medicine — not just HIV

drugs. The discomfort will usually lessen or go away completely. Be sure to read the

instructions that come with the drug and try any suggestions your medical provider

gives you for dealing with side eﬀects.

Call your doctor if:

• He or she has told you to call because the side eﬀect might mean you have to

stop taking the drug;

• The side eﬀect is making you feel so sick that you think you need to stop taking

the drug right away; or

• You have side eﬀects that were not listed with the drug information or that your

doctor didn’t explain to you.

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Diarrhea

If your HIV medications are causing the diarrhea, drink plenty of ﬂuids to replace

what you lose through diarrhea. Drinks like Gatorade that replace minerals and

nutrients are a good choice. Over-the-counter medications such as Imodium,

Kaopectate, Lomitil, or Pepto-Bismol can help. Many people with HIV have

controlled their diarrhea for years by eating some foods and avoiding others.

Diﬀerent things work for diﬀerent people. Try these tips:

• The BRAT diet: Bananas, Rice (white), Applesauce, and Toast. Oatmeal and tofu

can also help.

• Avoid spicy, fatty, starchy, or processed foods, caﬀeine, alcohol, dairy products,

and foods that give you gas (beans, broccoli).

• Try soluble ﬁber drinks (like Metamucil, Citrocel, or psyllium) or foods like oatmeal

or Cream of Wheat.

• Take calcium supplements (500 mg twice a day).

• Ask your doctor or nutritionist about digestive enzymes, acidophilus

or other suggestions.

Diarrhea will often decrease or go away if you try some of these steps. If you have

diarrhea for ﬁve days in a row or longer, or if you lose ﬁve pounds or more, tell

your doctor.

Feeling tired (fatigue)

Feeling tired (fatigue) is a common side eﬀect when you begin taking any

medication. Sometimes it is diﬃcult to tell whether the medication or the HIV itself

is tiring you out. Many people feel less tired as their bodies get used to a new drug

and the medications bring HIV under control.

You may feel tired due to anemia — a low level of red blood cells. Some HIV drugs,

like AZT, can cause anemia. If the anemia is severe, your doctor may change your

HIV medication or prescribe medication to increase your red blood cell count.

Here are some ways to help get your energy back:

• If your fatigue is not caused by anemia, try doing easy aerobic exercise — like

jogging, swimming, or biking — where you don’t push yourself and get out of

breath. Resistance exercise (weight lifting) is good, too.

• Keep a regular sleep schedule; too much sleep can make you feel more tired.

• Eat a balanced diet, with enough calories and protein. Drink plenty of ﬂuids.

• Talk to your doctor or a nutritionist about taking vitamins or supplements that are

safe to boost your energy level.

Headache

Headaches are a common side eﬀect of many HIV medications, especially during

the ﬁrst few weeks of taking a new drug. They may become worse when you’re

under pressure or feel tense. Several over-the-counter medications may help. These

steps may help with headaches:

• Eat regularly and drink plenty of ﬂuids.

• Sit or lie down in a quiet, dark room; place a cold wash cloth over your forehead

and eyes.

• Gently massage the base of your skull with your thumbs.

• Use aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin) according to

the directions on the label. Ask your doctor which pain reliever is best for you. Talk

with your doctor. If your headaches are very painful and occur often, they may be

migraine headaches that aren’t caused by your HIV medications and need special

treatment.

Liver problems

The liver releases enzymes — proteins that help you digest foods and process

the medications you take. Some HIV medications cause the release of too many

enzymes, which can damage the liver, especially in people who have both HIV and

hepatitis C. If you have previous liver damage from alcohol, street drugs, viral

hepatitis, HIV, or medications, this side eﬀect can become worse. Your doctor will

check your liver with blood tests on a regular schedule.

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Certain herbs and alternative treatments can also harm the liver. If you are taking or

planning to use herbal or alternative treatments, discuss them with your doctor to

make sure which ones are safe for you.

To reduce liver side eects:

• Drink less alcohol or stop drinking alcohol completely.

• Your doctor will probably do regular tests of your liver enzyme levels.

• Get a hepatitis test. If you test positive, there are treatments that may help.

If your liver is damaged, avoiding alcohol is the best thing you can do to keep it

healthy. Be sure to tell your doctor about all of the prescription drugs,

over-the-counter medications, and alternative treatments you take, including herbs

or vitamin supplements. Some of these treatments may be harmful to your liver.

Upset stomach (nausea), stomach pain, vomiting,

poor appetite

These common side eﬀects usually lessen or go away in a few weeks. If you vomit

or have stomach pain for several days in a row, call your doctor. Prescription drugs

called antiemetics can help control nausea and vomiting. Ask your doctor about

taking Compazine, Marinol, Zofran, or Phenergan. Over-the-counter drugs like

Pepto-Bismol may relieve nausea. To help settle an upset stomach:

• Use the Bananas, Rice (white), Applesauce, and Toast (BRAT) diet.

• Avoid hot, spicy, or greasy foods.

• Eat dry foods like crackers, toast, and dry cereal.

• Sip cold, carbonated drinks (like ginger ale) or try peppermint, chamomile,

or ginger tea.

Some medications are easier on the stomach if you take them with food. But some

HIV medications that you’re supposed to take with food may still be hard on your

stomach. Ask your doctor or nutritionist how to time your meals and medications to

avoid upsetting your stomach.

Long-term loss of appetite and weight loss

When you have HIV, long-term loss of appetite and weight loss can be a serious

problem. Starting a new medication may reduce your appetite or upset your

stomach so that you eat less. Try these steps to restore your appetite and avoid

weight loss:

• Eat foods that appeal to you even when you are not hungry.

• Eat ﬁve or six small meals a day rather than three large ones.

• Avoid foods and drinks that ﬁll you up but don’t provide useful calories.

• Try nutritional supplement drinks like Ensure or Boost.

• Keep track of your weight closely. Is your weight loss due to lack of appetite

or vomiting? Did it begin when you started a new medication? Is it related to

exercise, stress, or other factors? People with HIV need to maintain their weight. If

you feel that your medications are causing you to eat less or lose weight, talk with

your doctor or nutritionist.

Dietary supplements and natural therapies

Many people with HIV take over-the-counter supplements, herbs, and natural

therapies to improve their health and to reduce the side eﬀects of HIV drugs. Many

natural therapies have not been scientiﬁcally studied; several have their own side

eﬀects or may not be totally safe. Here are some things to remember:

• Nutritional supplement shakes are safe to drink and can help you keep weight on.

• A basic, single multivitamin pill is safe and healthy to use. Large doses of vitamins

and minerals can make you sick and may hurt your liver.

• Many herbal and natural remedies have not been scientiﬁcally studied. You can’t

tell how well they work, how much you should take, or whether they are safe.

• Some herbal products can aﬀect your HIV medications. Protease inhibitors will

not work if you take St. John’s Wort; and garlic supplements can block the eﬀect

of saquinavir. Some herbs and alternative treatments may also hurt your liver.

Tell your doctor about all of the medications or treatments you use, including

prescription drugs, over-the-counter drugs, and alternative treatments like herbs

or vitamin supplements.

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Side eects from dierent types of HIV drugs

This section describes side eﬀects that are common to each type, or class,

of HIV medication.

Protease inhibitors

Atazanavir (Reyataz)

Darunavir (Prezista)

Fosamprenavir (Lexiva)

Indinavir (Crixivan)

Nelﬁnavir (Viracept)

Tipranavir (Aptivus)

Ritonavir (Norvir)

Saquinavir (Invirase)

Fat problems (lipodystrophy)

Lipodystrophy is a change in the way your body stores fat. It may develop after

taking protease inhibitors for many months. If you have lipodystrophy, you may:

• Lose fat (lipoatrophy), especially in the arms, legs, buttocks, or face;

• Gain fat (lipohyperatrophy) in the waist, stomach, or breasts; or

• In rare cases, develop fat deposits at the base of the neck.

If you develop lipodystrophy, your doctor may advise you to change HIV medications,

get more exercise, change your diet, or undergo other medical or surgical treatments.

Metabolic problems

HIV medications can aﬀect your metabolism — the way your body stores and uses

its nutrients: sugars (glucose), fats, and proteins. HIV medications and HIV itself tend

to change the level of fats (triglycerides and cholesterol), sugar (glucose), and insulin,

which controls glucose in your blood. These metabolic changes can lead to heart

disease, heart attacks, stroke, or diabetes. Some HIV drugs cause metabolic problems

more often than others. Because you probably won’t feel these side eﬀects,

your doctor will need to do blood tests and exams to keep track of these levels.

Heart disease, heart attacks, stroke

Higher levels of fats in your blood can raise your risk of heart attack, heart disease,

diabetes, stroke, and pancreatitis. Protease inhibitors, especially ritonavir‚ seem to

increase fat levels in many people. During treatment, your doctor should test your

cholesterol and triglyceride levels regularly. If the levels get too high, these things

might help:

• Quit smoking.

• Get regular exercise.

• Change to a low-fat diet that lowers cholesterol.

• Ask your doctor about medications that can help lower your cholesterol.

Diabetes

Diabetes is a disease where your body doesn’t produce the right amount of insulin

to control your blood sugar (glucose).Too much glucose in the blood can slowly

damage the eyes, kidneys, blood vessels, heart, and nerves. Having high blood

pressure or high cholesterol or being overweight all raise your risk of getting

diabetes. Diabetes symptoms include being thirsty often, needing to urinate often,

and dry mouth.

If you have diabetes before you start taking HIV medications, or if you develop

diabetes, your doctor will create a diabetes treatment and nutrition plan. If your

doctor doesn’t have experience treating diabetes, ask for a referral to a specialist.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Abacavir (Ziagen)

Didanosine, ddl (Videx)

Emtricitabine (Emtriva)

Lamuvidine, 3TC, (Epivir)

Stavudine, d4t (Zerit)

Tenofovir (Viread)

Retrovir (Zidovudine)

Blood problems

Zidovudine and the medications containing zidovudine (Combivir, Trizivir) can slow

the production of diﬀerent types of blood cells. HIV itself may also be the cause.

Three main blood problems are:

• Anemia: a decrease in the number of red cells in your blood, which can make you

feel very tired.

• Neutropenia and leukopenia: a decrease in the number of white blood cells.

These cells ﬁght bacteria and infection and help to keep your immune system

healthy.

• Thrombocytopenia: a decrease in platelets, the cells that help your blood to clot

and stop bleeding.

If you have mild blood problems, you may not need to change your HIV medications

at all. Other prescription drugs can help your body produce more blood cells.

If you have a severe blood problem, your doctor will suggest changing HIV

medications.

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Sleeping problems (insomnia)

Insomnia is a common problem for people with HIV. It may be caused by the

disease itself or by HIV medications, such as Sustiva, Atripla or Maraviroc. Insomnia

may also be caused by other health problems, such as chronic pain, and the

medications used to treat those health problems. Some lifestyle habits and

activities may also need to be changed.

Try these tips for reducing insomnia:

• Avoid or reduce your use of alcohol and caﬀeine (including soda) in the evening.

• Keep a regular sleep schedule — go to bed and get up at the same time. Don’t

spend too much time in bed if you can’t get to sleep.

• Exercise regularly.

• Eat a consistent, healthy diet. Don’t go to bed hungry. In the evenings, eat foods

that increase your level of melatonin: chicken, turkey, rice, bananas, cottage

cheese, ginger, soy nuts, and pumpkin seeds.

• Talk with your doctor about the beneﬁts of using sleep supplements such as

melatonin.

• Use relaxation techniques as part of a bedtime routine to reduce restlessness and

anxiety and help you “wind down.”

• If you have been prescribed sleep medications, use them only when you really

need them.

Lactic acidosis

Lactic acid is produced as your body uses glucose (blood sugar). Lactic acidosis is an

uncommon but dangerous side eﬀect that occurs when your lactic acid level gets

too high. It is more common in women and in people who are very overweight. It

can lead to liver failure and death. It occurs most often in people who are taking

NRTIs. Symptoms include:

• Shortness of breath when exercising (if this has usually not happened to you

before);

• Feeling extremely tired;

• Upset stomach and throwing up;

• Stomach pain; and

• Bloating

If you feel several of these symptoms at the same time, call your doctor right away.

You will need a blood test to ﬁnd out if you have lactic acidosis.

Nerve problems, tingling hands and feet (neuropathy)

Neuropathy is damage to your nerves that gives you tingling, numbness, or

burning in the hands or feet that doesn’t go away. This side eﬀect happens mostly

with Stavudine and Didanosine and less commonly with Zidovudine. If the cause

of the neuropathy is not stopped, it can get worse and become very painful. Tell

your doctor if you get these symptoms in your hands and to see if the problem is

due to the medication or other causes, such as diabetes.

Here are some tips for managing neuropathy:

• Avoid long walks or standing for a long time.

• Soak your feet in cool water.

• Ask a friend to give you a massage.

• Keep your feet uncovered at night.

• Avoid tight socks or shoes.

If the HIV medication is the cause, your doctor may replace the drug with a diﬀerent

one. Milder cases of neuropathy can be treated with over-the-counter pain reliev-

ers or creams. For more serious cases, your doctor may prescribe a certain type of

antidepressant drug or a narcotic pain reliever.

Thinning bones (osteoporosis, osteopenia)

Everyone’s bones become thinner as they grow older — it’s a normal part of aging.

But there is evidence that some NRTIs may make your bones become thinner more

quickly than normal — so thin they might break more easily. This is called osteopo-

rosis or osteopenia.

Doctors generally do not recommend testing for thinning bones, except for women

who are past menopause. To reduce your risk of osteoporosis:

• Stop smoking;

• Get enough calcium (from supplements, dairy products, tofu);

• Get enough vitamin D (from sunlight, fortiﬁed milk, and fortiﬁed soy or rice milks); or

• Do weight-bearing exercise, like walking or weightlifting.

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Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Delavirdine (Rescriptor)

Efavirenz (Sustiva)

Etravirine (Intelence)

Nevirapine (Viramune)

Rilpivirine (Edurant)

Skin-related side eects

Some HIV medications (mostly NNRTIs) can cause a rash, itchiness, or very dry skin.

In rare cases of severe rash, symptoms can also include fever, throwing up, and

abdominal pain.

Call your doctor right away if you get a rash, especially if it itches or looks like hives

(large red bumps).

For less severe skin problems:

• Use a natural skin moisturizer, like aloe vera.

• Antihistamines like Benadryl can help clear up many mild rashes.

• Your doctor may prescribe an antihistamine or corticosteroid (like Prednisone)

for a more serious rash or itching.

• Avoid using harsh soaps and perfumes.

Fixed-Dose Combination Drugs

Efavirenz/emtricitabine/tenofovir (Atripla)

Lamivudine/zidovudine (Combivir)

Emtricitabine/rilpivirine/tenofovir (Complera)

Abacavir/lamivudine (Epzicom)

Lopinavir/ritonavir (Kaletra)

Elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild)

Abacavir/lamivudine/zidovudine (Trizivir)

Emtricitabine/tenofovir (Truvada)

HIV combination drugs

Some HIV medications have been combined into single pills. Combining

medications in one pill means you have to take fewer pills, which can make taking

HIV medications easier. But when you experience side eﬀects from combination

drugs, it’s more diﬃcult to determine which component medication is causing

the problem.

Speciﬁc side eﬀects for combination drugs are listed in the chart at the end

of this booklet.

Fusion inhibitors

Fusion inhibitors can help patients who are resistant to many other drugs from

other classes of HIV medications. Fuzeon (enfuvirtide,T-20) is the only approved

fusion inhibitor. Because patients inject Fuzeon twice a day, they sometimes have

problems with their skin — called injection site reactions — where they place the

shots. These problems can include itching, swelling, redness, pain and tenderness,

hardened skin, and bumps.

To reduce these eects:

• Try showering before taking the shot to soften the skin.

• Pinch a small layer of skin and fat between your thumb and index ﬁnger and

inject there so that you don’t push into muscle.

• Wear loose-ﬁtting clothes that don’t rub against the skin where the medication

was injected.

CCR5 Antagonists

(Chemokine Coreceptor Antagonists)

Maraviroc (Selzentry)

If you have liver problems — including hepatitis B or hepatitis C — kidney prob-

lems, or heart disease, tell your doctor before starting to take maraviroc. Symptoms

of liver problems can include yellow (jaundiced) skin or eyes, dark urine, an itchy

body rash, or stomach pain and vomiting. Because it can make you drowsy, don’t

drive or operate heavy equipment while ﬁrst taking maraviroc.

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Integrase Inhibitors

Raltegravir (Isentress)

Dolutegravir (Tivicay)

Elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild)

No serious side eﬀects have been associated with integrase inhibitors.

Drug-specic side eects

Abacavir: Severe allergic reaction

About 5 out of every 100 people who take abacavir (ABC, Ziagen) will have an allergic

reaction that can be dangerous. Abacavir is also contained in the combination drugs

Trizivir and Epzicom, which can produce the same allergic reaction. You may be

having this reaction if you have a type of skin rash or if you have two or more of the

following sets of symptoms when taking abacavir:

• Fever;

• Nausea, vomiting, diarrhea, or stomach pain; or

• Severe tiredness, achiness, or generally feeling ill.

If you notice these symptoms while taking abacavir, Trizivir or Epzicom, call

your doctor or clinic right away. These symptoms usually go away soon after you

stop taking Abacavir. Don’t resume taking the drug unless your doctor tells you the

symptoms were not part of a hypersensitivity reaction.

Tenofovir (Viread), Truvada, Atripla, Stribild, Complera:

Chronic renal insuciency (kidney failure)

HIV infection hurts the ability of the kidneys to function properly. Some HIV

medications also may harm the kidneys. Tenofovir (Viread), an NRTI, has caused

kidney failure in some patients. Tenofovir is also part of the combination drugs

Truvada, Atripla, Stribild, and Complera.

Tipranavir (Aptivus): Hepatotoxicity (liver injury)

If you have liver illness — such as chronic hepatitis B or hepatitis C — you could get

very sick from taking tipranavir. Your doctor will closely monitor your liver enzymes,

a measure of your liver health.

Efavirenz (Sustiva) and Atripla: Dizziness, confusion,

sleeping problems

About half the people who take these medications have one of these early side-

eﬀects: dizziness, confusion, trouble concentrating, sleeping problems, depression,

or anxiety. These nervous system side eﬀects usually lessen or go away in two to

four weeks. Many people ﬁnd that taking efavirenz or Atripla at bedtime reduces

these side eﬀects. Your doctor also may adjust the dosage. Here are some tips for

ﬁrst starting out with these drugs:

• Consider taking a few days oﬀ from work while you adjust to this medication.

• Don’t drive.

• Avoid alcohol.

• Don’t use recreational drugs, including marijuana.

• If you take efavirenz or Atripla before bedtime, don’t drink or eat anything with

caﬀeine or sugar for at least ﬁve hours beforehand.

Pancreatitis: didanosine (Videx), stavudine (Zerit); in children,

lamivudine (Epivir)

The pancreas produces ﬂuids that help the body digest and store food. HIV medica-

tions can cause problems with your pancreas (pancreatitis). Protease inhibitors can

increase amounts of fat in your blood, which can also cause pancreatitis.

Symptoms include:

• Stomach pain;

• Upset stomach (nausea);

• Throwing up;

• Yellow skin and/or yellowing of the whites of the eyes (jaundice).

Drinking less alcohol or no alcohol at all is the best way to reduce your risk of pan-

creatitis. Mild pancreatitis can be treated with special medications; your doctor may

stop prescribing any NRTIs.

15 | Managing Side Eﬀects of HIV Medications Managing Side Eﬀects of HIV Medications | 16

Conclusion: Keeping your quality of life

We know that drugs that ﬁght HIV improve the health of people with HIV. How you

feel when you take those drugs — your quality of life — is important, too. Most of

the side eﬀects you have from HIV medications will decrease over time. But if you

have side eﬀects that don’t go away, talk with your doctor, case manager, nurse,

nutritionist, pharmacist, or caregiver about what you can do. They may have tips to

help you reduce the symptoms and make the drug easier for you to take. Because

there are many diﬀerent medications that ﬁght HIV, your doctor will probably be

able to ﬁnd medications that work if you need to switch.

17 | Managing Side Eﬀects of HIV Medications Managing Side Eﬀects of HIV Medications | 18

Side Eects of HIV Medications

Anemia, other blood problems

Bone thinning

Depression, euphoria,

anxiety, hallucinations

Increased cholesterol, fats

Increased blood sugar

Lactic acidosis

Pancreatitis

Rash

Insomnia (sleeping problems)

Tingling hands, feet (neuropathy)

Chronic renal insuciency

Liver illness (hepatotoxicity)

Protease Inhibitors

Fosamprenavir (Lexiva) X X X X

Atazanavir (Reyataz) X

Darunavir (Prezista) X X X X

Lopinavir/Ritonavir (Kaletra) X X X

Nelﬁnavir (Viracept) X X X

Ritonavir (Norvir) X X X

Tipranavir (Aptivus) X X X X

Invirase (Saquinivir) X X X

Nucleoside Reverse Transcriptase Inhibitors

Abacavir (Ziagen) X X

Didanosine, ddl (Videx, Videx EC) X X X

Emtricitabine (Emtriva) X

Lamivudine (Epivir) X X*

Stavudine, d4T (Zerit, Zerit XR) X X

†

X X X

Tenofovir (Viread) X X X**

Zidovudine, AZT (Retrovir) ∆ X

Non-Nucleoside Reverse Transcriptase Inhibitors

Delavirdine, DLV (Rescriptor) X X

Efavirenz (Sustiva) X X X X

Etravirine, ETR (Intelence) X X

Rilpivirine (Edurant) X X

Rilpivirine/emtricitabine/

tenofovir (Complera)

X X

Nevirapine, NVP (Viramune, XR) X X

* Many people taking HIV medications

have no side eects at all.

* Be sure to talk to your doctor about

any side eects you experience.

* In most cases, side eects are

short term and your doctor can

help you manage them until

they disappear.

Anemia, other blood problems

Bone thinning

Depression, euphoria,

anxiety, hallucinations

Increased cholesterol, fats

Increased blood sugar

Lactic acidosis

Pancreatitis

Rash

Insomnia (sleeping problems)

Tingling hands, feet (neuropathy)

Chronic renal insuciency

Liver illness (hepatotoxicity)

Fixed-Dose Combinations

Abacavir/lamivudine (Epzicom) X* X

Abacavir/zidovudine/

lamivudine (Trizivir)

∆ X* X

Lamivudine/zidovudine (Combivir) ∆ X* X

Rilpivirine/emtricitabine/

tenofovir (Complera)

Tenofovir/emtricitabine (Truvada) X X X

Tenofovir/emtricitabine/

elvitegravir (Stribild)

∆ X X X

Fusion Inhibitors

Enfuvirtide (Fuzeon) X

Entry Inhibitors

Maraviroc (Selzentry) X X

Integrase Inhibitors

Dolutegravir (Tivicay)

Raltegravir (Isentress)

Headache, diarrhea, and nausea are possible side eﬀects of any HIV medication, so they are not included in this chart.

For a complete description of side eﬀects, please go to www.health.ny.gov/publications/9408.pdf .

Symbol key: ∆ = hepatitis B infection may worsen if patient stops use; X* = in children; X** = If patient has chronic hepatitis C

or history of kidney illness; X

†

= most likely cause.

9408

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