Side Effects

The Well Project

Submitted on Jun 17, 2016

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Table of Contents

• Side Effects and HIV Drugs
• Knowing about Side Effects Can Help
• Women and Side Effects
• More Common Side Effects
• More Serious Side Effects
• Other Possible Side Effects
• Side Effects or Toxicities during Pregnancy
• Taking Care of Yourself

Side Effects and HIV Drugs

Over the years, many HIV drugs have been developed that help people live longer, healthier lives. Like all drugs approved by the US Food and Drug Administration (FDA), HIV drugs are tested to make sure they are safe and effective in treating HIV. However, HIV drugs can also cause some effects that are different from what they were developed to do. These are called side effects. In most cases, the side effects of HIV drugs are mild, like a headache or an upset stomach. In some cases, however, more serious side effects like liver damage or peripheral neuropathy can occur.

Side effects are most common during the first four to six weeks you are taking a new HIV medication. After your body gets used to the new drug, the side effects usually get better or go away. Other side effects may show up later or last longer. There may also be long-term side effects we do not know about yet. Several of the HIV drugs have not been on the market long enough for us to know all the possible long-term effects.

Click here to view ordownload fact sheet as a PDF slide presentation

Knowing about Side Effects Can Help

Each HIV drug comes with information on its most common side effects. It can help to read this information. If you read the package insert provided by the drug manufacturer, the list of possible side effects can be very long and detailed. For some, reading through that list can be downright scary. However, it is important to remember that this information lists side effects you might experience, not side effects you will experience. 

While all HIV drugs can cause side effects, not everyone will experience every side effect of each drug, and not everyone will experience the side effect(s) the same way.

Speak to your health care provider about side effects before starting a new treatment. It will help if you know what to expect and how to handle any problems that arise. Some important points:

• Find out what side effects are possible for any new drug you are taking. Drugs often have lists of the most common side effects you can expect, so that you can prepare for and keep an eye out for them.
• Ask if there are ways of taking the drug that make it easier to tolerate – for example with or without food or at a certain time of day, such as bedtime
• Find out if you can treat mild side effects with home remedies, over-the-counter medications, or prescription drugs and have these treatments on hand, especially for common side effects like diarrhea and nausea
• Ask when you should get medical attention for a side effect, and whom to contact if it is after hours when the side effect occurs
• Let your health care provider know if you are experiencing side effects, especially if you are taking a drug that may cause a particularly serious problem

Whether your side effects are considered mild or serious, if they are getting in the way of you taking your HIV drugs (see our article on adherence), they are a very important concern. If you do experience side effects, it is important that you not stop taking your medication on your own. Talk to your health care provider, who will help you by suggesting ways to address the side effect directly, changing the dose of the drug, or switching drugs.

Women and Side Effects

Although the total number of side effects among people on HIV drugs does not differ a lot between men and women, some side effects (listed below) appear to be more common in women living with HIV (HIV+) than in men.

This may be due to the fact that women have higher levels of certain HIV drugs in their bloodstreams, even though they take the same doses as men. A woman's smaller body size, metabolism (how we break down drugs in our bodies), or hormones may cause the higher levels. For example, with the protease inhibitor (PI) Norvir (ritonavir), women seem to experience more nausea, vomiting, and weakness than men.

Despite some differences in drug levels and side effects, women seem to benefit as much from HIV therapy as men. No changes in dosing have been recommended for women.

More Common Side Effects

Below is a list of more common side effects associated with HIV drugs. Click the available links for more detailed information on the side effects listed.

Nausea and Vomiting

Nausea, or feeling sick to your stomach, is one of the most common side effects of taking HIV drugs. Vomiting, or throwing up, is also very common. Both of these occur when new, unknown substances – like HIV drugs – are introduced to our bodies.

The good news is that, when nausea and vomiting occur as side effects of new HIV drugs, they often get better after the first days or weeks of treatment. However, they can still be awfully unpleasant and reduce the quality of your daily life. Nausea and vomiting can get in the way of your taking your HIV drugs regularly or benefitting from the drugs you take (if you throw them up before they are digested). These side effects can also keep you from getting the proper nutrition your body needs.

It is important that you tell your health care provider if nausea is affecting your quality of life, especially your ability to eat and take medications. It is also important to tell your provider if you have vomiting lasting more than a few days, as that may lead to more serious problems.

Because nausea and vomiting are such common side effects with so many of the HIV drugs, switching drugs is often not helpful. Instead, there are some things you can do to manage nausea and vomiting:

• Eat smaller meals more often. Large amounts of food in the stomach can make nausea worse.
• Eat bland, rather than spicy foods. Bland foods are easier to digest.
• Eat room temperature foods. Very cold or very hot foods can make nausea worse.
• Ginger and peppermint have long been known to ease the stomach. Try ginger ale, ginger tea, or peppermint tea.
• Breathe slowly – in through the nose, out through the mouth. Try to avoid strong smells, like perfume, smoke, incense, or food smells.

If these tips do not work, there are prescription medications to prevent nausea and vomiting. For example, there are medications your provider can prescribe that you can take before taking your HIV drugs to decrease the feeling of nausea. These medications can help you be much more successful in taking your HIV drugs. Talk to your health care provider about which of these medications would be best for you.

Diarrhea

Diarrhea occurs when you have bowel movements more often than you usually do and/or have very loose, watery stool. Like nausea and vomiting, diarrhea can be unpleasant and reduce the quality of your life. It can also lead to dehydration and malnutrition (not getting enough nutrients from your food).

It is important to tell your health care provider if you have diarrhea for more than a few days so that he or she can find the cause and suggest appropriate treatments.

There are many approaches to treating or managing diarrhea:

• Dietary changes:
• Increase fluid intake to avoid dehydration
• Eat small meals every two to three hours
• Avoid fatty foods, very sweet or spicy foods, caffeine (found in coffee, chocolate, sodas, and some teas), 'roughage' (lettuce, greens, seeds, corn, bran), raw or undercooked foods
• Try the BRATT diet: Bananas, Rice (white), Applesauce, Toast (white), and Tea (unsweetened and non-caffeinated)
• Herbal remedies: Chamomile, ginger, and peppermint teas have calming effects on the gut
• Supplements, including probiotics, L-glutamine, and calcium carbonate
• Over-the-counter medications
• Prescription medications: There are medications your provider can prescribe that you can take with your HIV drugs to prevent diarrhea. These medications can help you be much more successful in taking your HIV drugs.

For more information on managing your diarrhea, please see our fact sheet on Diarrhea.

Headaches

Some HIV drugs can cause headaches. Mild headaches that go away with over-the-counter pain killers like aspirin, Tylenol (acetaminophen), Advil or Motrin (ibuprofen), or Aleve (naproxen sodium), are usually not a sign of a serious condition or disease. However, if you experience severe pain, changes to your vision, dizziness, neck stiffness, or fever, along with nausea and/or vomiting, tell your health care provider immediately, as these symptoms can indicate something more serious. Also tell your provider if your headaches are affecting your quality of life or ability to stick to your HIV drug regimen.

If headaches are bothering you, ask your health care provider if over-the-counter pain relievers are right for you. You may also consider alternative or complementary therapies to manage headaches.

Rash

Rash is a common side effect of many of the HIV drugs, especially the non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as Viramune (nevirapine), Sustiva (efavirenz), Intelence (etravirine), and Edurant (rilpivirine). Rashes are more common and more severe in women. It is important to check your skin for changes in color or any unusual bumps, especially after starting a new medication.

In rare situations, a rash is a symptom of a severe, life-threatening skin reaction called Stevens-Johnson syndrome. Call your health care provider immediately if you experience a bad rash or a rash together with any of the following symptoms: fever, lack of energy, general feeling of illness, muscle or joint aches, itchiness of the skin, mouth sores, bloodshot or dry eyes, and blisters, especially those that look like "targets," or "bulls-eyes."

More Serious Side Effects

Below is a list of less common, more serious side effects associated with HIV drugs. Click the available links for more detailed information on the side effects listed.

Kidney Problems

The kidneys are the two fist-sized, bean-shaped organs that filter blood and produce urine. They get rid of waste and maintain a healthy balance of many substances, including water and electrolytes.

Often, those with kidney disease – especially early kidney disease – do not notice any symptoms. This is why it is important to see your health care provider regularly for lab tests that pick up changes to your kidney function. Symptoms of kidney disease can include: too much or too little urine; urine that is foamy, pink, red, or brown; swollen hands or feet; muscle aches or cramps; fatigue and trouble concentrating.

Sometimes people develop a serious condition called acute renal failure (ARF) in response to certain HIV drugs. ARF happens when serious damage to the kidneys occurs in a short amount of time. ARF can lead to permanent kidney damage.

Liver Problems

Some HIV drugs can cause liver problems. It is believed that women and people over the age of 50 are at higher risk of developing liver problems. Obesity, heavy alcohol use, and other liver problems (such as hepatitis B and hepatitis C) can also increase this risk.

Some drugs, such as Viramune, can cause an allergic reaction in the liver that increases the liver enzymes in your blood soon after the medication is started. It is important that your health care provider do a blood test to check your liver frequently during the first few months that you are on this medication.

In addition, research has shown that women with more than 250 CD4 cells are 12 times more likely to develop life-threatening liver problems when they start Viramune. Viramune should not be used as first-time treatment in women with CD4 cell counts over 250. Women with over 250 CD4 cells should not switch to Viramune unless there are no other options. Women whose CD4 cells were below 250 when they started Viramune and rise to over 250 while taking it do not need to discontinue or switch their treatment.

For more information on this topic, please see our fact sheet on Caring for your Liver.

Lipodystrophy

The term lipodystrophy is used to describe a number of body shape changes that result from the addition or loss of body fat. While men and women living with HIV (HIV+) both experience body shape changes, women are more likely to experience fat gain in the breasts, stomach, and upper bodies. Lipodystrophy can cause big changes in your appearance. If you are concerned about how you look, speak to your health care provider before making any changes to your HIV drug regimen.

Lipodystrophy also involves metabolic problems such as high blood glucose (sugar) and high lipid levels (cholesterol and triglycerides). The exact causes of lipodystrophy are not known, but may include HIV and/or certain HIV drugs.

For more information on this topic, see our fact sheet on Lipodystrophy and Body Changes.

Peripheral Neuropathy

 

Peripheral neuropathy (PN) happens when the nerves between the feet and/or hands and the spinal cord become damaged. Like frayed wires that can spark or misfire, these damaged nerves do not send their electrical signals properly. As a result, PN can cause feelings of numbness, tingling, burning, itching, or shooting pain. Some people with PN describe their pain as "holding a lit match to my feet," or "walking on broken glass."

PN pain can be constant or occasional, and usually occurs on both sides of the body. Some older HIV drugs such as Zerit (stavudine) and Videx (didanosine) can be toxic to the nerves and cause PN. The good news is these drugs are rarely used now. Unfortunately, there are no approved medical treatments to cure PN. For now, the key to treating PN is to remove the cause and control the pain.

There are causes of PN other than HIV drugs. It is important to talk with your provider if you have symptoms of PN. For more information on this topic, see our fact sheet on Peripheral Neuropathy.

Lactic Acidosis

Lactic Acidosis is a buildup of lactic acid in the blood. It is a rare but serious complication of some nucleoside reverse transcriptase inhibitors (NRTIs) such as Zerit and Videx (which are now rarely used). Women (especially pregnant women), overweight people, and those with a long history of NRTI use are more likely to develop lactic acidosis. Symptoms include fatigue, nausea, vomiting, stomach pain, shortness of breath, and weakness in the arms and legs. If you notice any of these symptoms, call your health care provider right away.

For more information on this topic, see our fact sheet on Lactic Acidosis.

Other Possible Side Effects

Taking HIV drugs can also affect your heart and bone health. For more information, see our fact sheets on Caring for your Heart and Bone Health.

In addition to the side effects listed above, you can find more information on other possible side effects in the Health and Medical Issues section our website.

Side Effects or Toxicities during Pregnancy

The majority of studies have shown that taking HIV drugs during pregnancy does not increase the risk of birth defects. However, there are certain HIV drugs that should not be used by pregnant women because of potential problems for the mother or the baby.

Women living with HIV should not take Zerit and Videx at the same time if they are pregnant. Some pregnant women who took these drugs together developed lactic acidosis, which resulted in deaths.

Guidelines on taking efavirenz (brand name Sustiva; also found in Atripla) during early pregnancy remain conflicted. The US Department of Health and Human Services’ HIV Treatment Guidelines recommend that (1) women who wish to become pregnant not take efavirenz because it may cause birth defects when taken during early pregnancy, and (2) taking efavirenz appears safe after eight weeks of pregnancy. The World Health Organization (WHO)’s guidelines, however, suggest that efavirenz can be taken throughout pregnancy, including during the first trimester (12 weeks). The WHO’s recommendations are based on a report in which researchers reviewed many different studies and found no connection between taking efavirenz during the first trimester of pregnancy and an increased risk of birth defects.

If you are pregnant or thinking about getting pregnant, speak to your health care provider about all of your medications to be sure there are no specific warnings for pregnant women. The good news is there are several HIV drugs that are safe to take during pregnancy. If taken as directed, these HIV drugs can make the chances that you will pass HIV on to your baby very low (less than one in 100).

Taking Care of Yourself

HIV drugs help many people live longer, healthier lives. Side effects are an important factor in determining who stays on their HIV drugs. While the term 'side effects' may make them sound like they are not a big problem, if they are getting in the way of your taking your HIV drugs, they may get in the way of your good health. If you are having trouble sticking to your HIV drug regimen because of problems with side effects, speak to your health care provider before skipping, reducing, or stopping your drugs. There is usually something that can be done about it, such as changing the dose of that drug, switching to another drug, or finding ways to treat or manage the side effect directly.

Read more articles from The Well Project, here.