This section of the booklet provides some more information on the commonest side-effects that the anti-HIV drugs currently in use can cause.

It is intended to provide you with information to help you recognise a side-effect should you develop one. There’s also information on what you can do to help control side-effects.

It makes good sense to remember a few things about side-effects:

• Many symptoms, for example headaches, diarrhoea, feeling or being sick and rashes can have causes other than anti-HIV drugs. If you develop such a symptom HIV treatment might not be the cause.
• Mention suspected side-effects to your doctor. It is important to find out the cause of symptoms you are experiencing.
• You do not have to put up with side-effects – there is nearly always something that can be done about them.

Diarrhoea is a possible side-effect of most anti-HIV drugs.

With some drugs, diarrhoea goes away after the first few weeks or months of treatment; however, for some people it becomes a permanent feature of taking a particular drug.

Changes in diet have little effect on protease inhibitor and other drug-related diarrhoea. However, a variety of treatments are available which can help control diarrhoea, particularly the anti-diarrhoea medicine loperamide (trade name Imodium). Your doctor should give you a prescription for this if you start any HIV treatment that can cause diarrhoea.

It is important that you continue to eat and drink even if you have diarrhoea caused by your medication. If diarrhoea is a problem for you, then it is a good idea to talk to your doctor about your options.

Remember that diarrhoea can have other causes as well, so it makes good sense to tell your doctor if you have persistent diarrhoea so its cause can be investigated.

There is more information on how to deal with diarrhoea in the NAM booklet, Nutrition.

Feeling sick (nausea) or being sick (vomiting) are possible side-effects of most anti-HIV drugs. Your doctor should give you pills to stop you being sick if you are starting an anti-HIV drug that has nausea and vomiting as a possible side-effect.

As with many other possible side-effects, nausea and vomiting tend to be worst in the first few weeks after you start treatment and then often lessen or go away completely.

Nausea and vomiting can have other causes, so your HIV treatment might not be the cause. It makes good sense to tell your HIV doctor if you are feeling sick or being sick, particularly if you have other symptoms as well, especially a fever.

Whatever the cause, do not feel obliged to just put up with it – nausea and vomiting can prevent you from getting enough food and nutrients and from sticking with your HIV treatment. As well as asking your doctor about anti-sickness medication, the following practical tips may be helpful and can be discussed with your doctor, pharmacist or a dietitian:

• Eat small, frequent meals throughout the day rather than two or three large meals.
• Don't eat liquid and solid food at the same meal. Space them at least one hour apart.
• Avoid eating greasy, fatty, fried or spicy food. Instead, choose bland food.
• Try dry food such as toast, crackers, cereal, and fruit and vegetables that are bland or soft.
• Salty food such as crackers, pretzels and popcorn can help reduce nausea. Carry a packet with you when you leave the house.
• Don't lie flat for at least an hour after you eat.
• Eat food cold or at room temperature – hot food can worsen nausea.

Herbal tea (e.g. peppermint or chamomile) or root ginger can help settle upset stomachs.

Headache is a possible side-effect of many anti-HIV drugs. In most cases, these are mild and lessen or go away completely after a few weeks of treatment with the drug. Pain killers like paracetamol can provide relief.

It makes good sense to tell your doctor about headaches, particularly if they are severe or last more than a few days.

Efavirenz (Sustiva), FTC (emtricitabine, Emtriva) and tenofovir (Viread), drugs that are combined in the once-daily pill Atripla, can cause a number of mood and sleep problems.

When these side-effects occur, they are normally mild and lessen or go away after a few weeks of treatment. But for some people they are not tolerable and they need to change treatment because of them. Tell your doctor if you are experiencing these side-effects.

Some people find that taking their medication just before going to bed helps. A short course of sleeping tablets may also help to re-establish your sleep patterns.

Rash can be a side-effect of a number of anti-HIV drugs.

Such rashes often lessen or go away after a few weeks of treatment, but even so it is a good idea to report rashes to your doctor as some rashes can indicate the presence of serious side-effects (particularly if you are taking abacavir or nevirapine), or infections.

Sexual problems (sometimes called sexual dysfunction) are common in people with HIV. They are often thought of as a side-effect of HIV treatment, but can have a number of possible causes, so it’s often difficult to say if HIV treatment is the cause.

Sexual problems can include a loss of interest in sex, or reduced sexual performance (for example, delayed orgasm or an inability to achieve and maintain an erection).

As well as treatment side-effects (not only of HIV drugs but of commonly used medicines like antidepressants as well), possible causes also include anxiety and stress, mental health problems like depression, drug and alcohol use, illness and ageing.

More is known about sexual problems in HIV-positive men than HIV-positive women. Protease inhibitors are the type of anti-HIV drug most associated with sexual problems in men – normally problems achieving or maintaining an erection.

The extent to which protease inhibitors cause erectile problems is far from certain, and it’s not inevitable that you’ll develop such problems if you start treatment with a protease inhibitor.

If you do develop sexual problems, it’s good to know that there’s a lot that can be done about them. It makes good sense to mention them to a member of your healthcare team.

It’s important to consider if there are any psychological issues that could be contributing to your sexual problems. 

There could be medical causes for your sexual problems, so your doctor may do tests to monitor your testosterone level or check the health of your heart and arteries.

Medicines are available to treat erectile dysfunction in men. They are called Cialis, Levitra and Viagra. They work by increasing the flow of blood to the penis.

Your doctor may be able to provide you with an NHS prescription for these drugs, or it may be possible to have them prescribed privately.

All three of these drugs can interact with anti-HIV drugs, particularly protease inhibitors and NNRTIs. If you are taking HIV treatment, your prescribed dose of an erectile dysfunction drug will be reduced to half the standard dose.

Tell your HIV doctor or pharmacist about other medicines you are taking as some can interact with erectile dysfunction drugs.

And it’s important to know that you shouldn’t use poppers if you are taking erectile dysfunction drugs as this combination can cause a potentially dangerous drop in blood pressure.

Tiredness (fatigue) is a possible side-effect of most anti-HIV drugs. 

As with most other side-effects, the risk of fatigue is greatest in the first few weeks after you start treatment with a drug, and then lessens or goes away completely.

It makes good sense to tell your doctor if fatigue is a problem for you. If the cause is your HIV treatment there is a good chance that something can be done about it. Fatigue can have other causes as well, so mention tiredness to your doctor so he or she can investigate possible causes.

Getting enough sleep, eating a good balanced diet, and regular exercise can also help with fatigue.