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Common side-effects

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.

Key things to remember 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

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. Try to avoid coffee, raw vegetables and spicy food as they can make diarrhoea worse.

Changes in diet have little effect on drug-related diarrhoea. However a variety of treatments are available which can help control diarrhoea, particularly the anti-diarrhoea medicine loperamide (sometimes known by its trade name Imodium). Your doctor should give you a prescription for this if you start any HIV treatment that can cause diarrhoea, or you can buy it over the counter at a pharmacy. Stronger anti-diarrhoea drugs, such as lomotil or octreotide, can be prescribed by your doctor.

It is important that you continue to eat and drink even if you have diarrhoea caused by your medication. Diarrhoea can cause you to lose large amounts of salts and water from your body, so it is important to drink plenty of fluids. Rehydration drinks (for example, Diarolyte) can help replace sugars and salts as well as providing extra fluids. You can buy these at a chemist or supermarket.

Eating foods like bananas, potatoes, chicken or fish will help you replace potassium, levels of which are commonly reduced in people with severe diarrhoea. Soluble fibre from natural sources like white rice, white pasta, pulses, oats, bananas, apples and pears can help reduce diarrhoea.

In many cases, avoiding foods that are high in fat, bulky (insoluble) fibre (such as whole grains, nuts and seeds), or lactose (found in dairy products such as cow’s milk and cheese) may help reduce the symptoms of diarrhoea.

If you are losing weight because of diarrhoea, it is important to speak to a dietitian as soon as possible who will work with you to develop a diet which is more appetising, or easy to absorb.

Diarrhoea can have other causes. If you have diarrhoea for more than a few days, especially if you feel unwell, you should see your doctor. They may suggest you have a stool sample checked for infections.

Increasing or decreasing the fibre content of your diet may help if you have irritable bowel syndrome, as might anti-spasmodic therapies such as Colofac.

Feeling or being sick

Feeling sick (nausea) or being sick (vomiting) are possible side-effects of most anti-HIV drugs. Your doctor may give you pills (called anti-emetics) to stop you being sick if you are starting an anti-HIV drug that has nausea and vomiting as a possible side-effect. Taking these about 30 minutes before you take your anti-HIV drugs can help prevent these symptoms.

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

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 such as 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.

Mood and sleep problems

Efavirenz (Sustiva, also in the combination pill, Atripla), can cause a number of mood and sleep problems, including anxiety and depression, feeling spaced out during the day or having vivid dreams at night. Rilpivirine (Edurant) can also cause mood changes and depression.

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. If you have a history of mental health problems, these drugs may not a good choice for you.

Some people find that taking efavirenz just before going to bed helps them to feel better during the day. A short course of sleeping tablets may also help to re-establish your sleep patterns.

You can find out more about managing mood changes, anxiety and depression, and looking after your emotional wellbeing, in the booklet in this series HIV, mental health & emotional wellbeing.

Rash

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. Even so it is a good idea to report rashes to your doctor. A rash can also be a sign of an infection. Some rashes can indicate the presence of serious side-effects. This is particularly important if you are taking abacavir, etravirine, maraviroc, nevirapine or raltegravir, where there is a possibility of a serious hypersensitivity (allergic) reaction. See Hypersensitivity (allergic) reactions for more information on what symptoms to look out for. It’s important you take fast action if you think you are suffering from this sort of reaction.

People starting HIV treatment with nevirapine will take a 14-day reduced lead-in dose (200mg) of immediate-release nevirapine in order to reduce the risk of rash, a common side-effect during the first few weeks of nevirapine treatment. Treatment with Viramune prolonged-release should not begin until the rash has gone away. Always tell your doctor about any rash you develop while taking nevirapine. If a rash persists for more than one month, or becomes more severe, a different drug should be used.

Sexual problems

Sexual problems (sometimes called sexual dysfunction) are common in people with HIV. They are sometimes 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 such as depression, drug and alcohol use, illness, and ageing.

More is known about sexual problems in men with HIV than women with HIV. 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 so it makes good sense to mention them to a member of your healthcare team.

There could be other 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.

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

Medicines are available to treat erectile dysfunction in men. These are called tadalafil (Cialis), vardenafil (Levitra) and sildenafil (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.

You shouldn’t use poppers if you are taking erectile dysfunction drugs as this can cause a potentially dangerous drop in blood pressure.

You can find out more about dealing with sexual problems in NAM’s booklet HIV & sex.

Tiredness

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 it is likely to lessen or go 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 tell your doctor about prolonged tiredness so he or she can investigate possible causes.

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

Side-effects

Published July 2013

Last reviewed July 2013

Next review July 2016

Contact NAM to find out more about the scientific research and information used to produce this booklet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.