The most common side effects for antiretroviral therapy for each drug and by drug class.

Remember that some side effects are more common than others, and each person may react differently to the same medicine. For this reason, a drug regimen can’t be based solely on possible side effects. While taking medications, discuss any physical changes or new symptoms with your doctor and pharmacist. Some side effects can be managed or controlled, while others require intervention or medication changes. Although not always stated here, some side effects may be rare. See drug page or package insert for more information.


There are both benefits and potential side effects associated with HIV medications, known as antiretroviral therapy (ART). Benefits of ART include restoration of the immune system and reduction in risk of HIV transmission, especially if the viral load is undetectable (less than 50 copies/mL). Safer sex methods should be practiced, and additional information regarding HIV transmission can be found at One potential side effect of ART is known as immune reconstitution inflammatory syndrome (IRIS), which may occur as the immune system regains strength following initiation of therapy. Symptoms of illnesses such as shingles and tuberculosis should be reported to a health care provider immediately.


POTENTIAL DRUG CLASS SIDE EFFECTS: Rare but potentially serious side effects with all NRTIs are enlarged, fatty liver and lactic acidosis (accumulation of lactate in the blood and abnormal acid-base balance). Lactic acidosis may cause persistent fatigue, abdominal pain or distension, nausea/vomiting, and difficulty breathing. These conditions are seen even less with newer and now commonly used NRTIs (specifically Epzicom and Truvada).


lamivudine / zidovudine—fixed-dose combination

See Epivir and Retrovir.


emtricitabine, or FTC

A very tolerable drug, but side effects may include headache, diarrhea, and nausea. A flare-up of existing hepatitis B may occur when stopping Emtriva. Darkening of the skin on the palms and the soles of the feet has also been reported.


lamivudine, or 3TC

A very tolerable drug, but side effects may include headache, nausea, vomiting, diarrhea, fever, fatigue, hair loss, insomnia, malaise (general ill feeling), nasal symptoms, and cough. A flare-up of existing hepatitis B may occur when stopping Epivir.


abacavir / lamivudine—fixed-dose combination

See Ziagen and Epivir.


zidovudine, AZT, or ZDV

Headaches, fever, chills, muscle soreness and/or damage, fatigue, nausea, lipoatrophy (fat loss in the arms, legs, face, and/or buttocks—sometimes called “AZT butt”), blue/black nail discoloration, anemia (low red blood cell count), and neutropenia (low white blood cell count).


abacavir / lamivudine / zidovudine—fixed-dose combination

See Ziagen, Epivir, and Retrovir.


emtricitabine / tenofovir

See Emtriva and Viread. Abdominal distension/pain.

Videx EC

didanosine, or ddI

Peripheral neuropathy (tingling, burning, numbness or pain in the hands or feet), upset stomach, diarrhea, vomiting, rash, pruritis (itchiness), and headache. Pancreatitis and lactic acidosis. Eye changes and optic neuritis. Increased uric acid levels, alkaline phosphatase, and amylase levels. Body fat redistribution, insulin resistance, and diabetes. Non-cirrhotic portal hypertension.


tenofovir, or TDF

A very tolerable drug, but side effects may include headache, diarrhea, pain, depression, nausea, weakness, and gas. Kidney toxicities and decreased bone mineral density. A flare-up of existing hepatitis B may occur when stopping tenofovir.


stavudine, or d4T

Headache, diarrhea, nausea, vomiting, rash, peripheral neuropathy (tingling, burning, numbness or pain in the hands or feet), pancreatitis, lipoatrophy (fat loss in the arms, legs, face, and/or buttocks), mitochondrial toxicities (a variety of symptoms caused by cell damage), and elevated cholesterol levels.


abacavir, or ABC

Hypersensitivity reaction, nausea, vomiting, diarrhea, fatigue, headache, fever, rash, trouble sleeping, unusual dreams, anorexia (loss of appetite), and potential for increased cardiovascular event, especially in patients with risk factors.


POTENTIAL DRUG CLASS SIDE EFFECTS: Common with NNRTIs is rash, and rarely, severe rash which may require immediate medical attention.


rilpivirine, or RPV

Insomnia, headache, rash, and depressive disorders. Liver problems may occur. Nephrotic syndrome (kidney disorder, which may not be related to rilpivirine).


etravirine, or ETR

Rash and increased cholesterol. Skin or hypersensitivity reactions. Rarely, peripheral neuropathy.


delavirdine, or DLV

Increased liver enzyme levels and itchy skin or rash.


efavirenz, or EFV

Central nervous system (CNS) and psychiatric symptoms. Rash, nausea, vomiting, diarrhea, fever, and increases in triglycerides, cholesterol, and liver enzyme levels. False positive tests for marijuana. Birth defects.

Viramune XR

nevirapine, or NVP

Headache, nausea, vomiting, fever, rash, Stevens-Johnson syndrome, increased liver enzyme levels, liver damage, and drug-induced hepatitis.


POTENTIAL DRUG CLASS SIDE EFFECTS: The most common class side effects of protease inhibitors include gastrointestinal (GI) side effects such as nausea, vomiting, and diarrhea. These occur most frequently only at the beginning of therapy. Additional side effects seen with most PIs (except for unboosted Reyataz) include increased levels of total cholesterol, triglycerides, and blood sugar, which may be associated with an increased risk of heart disease. Other possible side effects include lipodystrophy (body fat changes), liver toxicity, osteoporosis, increased bleeding in hemophiliacs, and rash (especially with sulfa allergies). Medical attention needed for severe rash.


tipranavir, or TPV

(must be taken with Norvir)

Use with caution in patients allergic to sulfa drugs. Most common are mild diarrhea, nausea, vomiting, abdominal pain, and fatigue. Other side effects may include headache, fever, dry mouth, dizziness, rash (including sensitivity to the sun), liver abnormalities, and bleeding in the brain. May also increase blood sugar, cholesterol, and triglycerides.

Also see Norvir.


indinavir sulfate, or IDV

Kidney stones, itchy/dry skin, ingrown toe nails, hair loss, headache, fatigue, weakness, malaise (general ill feeling), nausea, diarrhea, stomach pain, loss of appetite, yellowing of skin/eyes, changed skin color, dry mouth/sore throat, taste changes, painful urination, indigestion, joint pain, hives, liver toxicity, Stevens-Johnson syndrome, hemolytic anemia, diabetic ketoacidosis, increase in bilirubin, insulin resistance, diabetes, body fat changes, and increased cholesterol levels. Kidney stones and jaundice can be minimized or avoided by drinking at least 1.5 liters of water per day.


saquinavir, or SQV

(must be taken with Norvir)

Most common side effects are diarrhea, abdominal discomfort, vomiting, and nausea. Other side effects may include lipodystrophy and potential heart problems when given with certain other medications. Also see Norvir.


lopinavir / ritonavir, or LPV / r

Diarrhea is the most common side effect. Other side effects may include elevated cholesterol and triglycerides (fat in the blood), insulin resistance, rash, nausea, vomiting, stomach pain, headache, muscle weakness, and lipodystrophy. Also see Norvir.


fosamprenavir calcium, or FPV

Use with caution in patients allergic to sulfa drugs. Nausea, rash, diarrhea, headache, vomiting, and elevated liver enzymes.


ritonavir, or RTV

Weakness; stomach pain; nausea; diarrhea; vomiting; tingling/numbness around the mouth, hands, or feet; loss of appetite; taste disturbance; weight loss; headache; dizziness; pancreatitis; alcohol intolerance; increased liver enzyme levels; hepatitis (liver inflammation); jaundice (yellowing of skin or eyes); increased muscle enzyme (CPK); and uric acid.


darunavir, or DRV

(must be taken with Norvir)

Use with caution in patients allergic to sulfa drugs. Side effects may include: diarrhea, nausea, headache, rash, vomiting, and abdominal pain. Also see Norvir.


atazanavir sulfate, or ATV

Dizziness, nausea, possible jaundice (yellowing of the skin or eyes), rash, kidney stones, gall stones, abnormal heart rhythm, and elevated liver enzymes


nelfinavir, or NFV

Diarrhea, stomach discomfort, nausea, gas, weakness, and rash.

PI-PKE Boosted PIs Protease inhibitors containing cobicistat booster

POTENTIAL DRUG CLASS SIDE EFFECTS: Because boosted protease inhibitors contain two medicines from different drug classes, you should look up each drug contained in the pill.


atazanavir / cobicistat

See Reyataz and Tybost.


darunavir / cobicistat

See Prezista and Tybost.


POTENTIAL DRUG CLASS SIDE EFFECTS: No class side effects known to date.


raltegravir, or RAL

Very tolerable and infrequent side effects, which may include diarrhea, insomnia, nausea, headache, dizziness, and fatigue. Rare side effects may include abdominal pain; vomiting; weakness; mild to moderate rash; anxiety; anemia (low red blood cells); neutropenia (low white blood cells); lipodystrophy; elevated levels of creatine kinase; increases in ALT, AST, and total bilirubin; hypersensitivity reactions; and cerebellar ataxia. Chewable tablets contain phenylalanine.


dolutegravir, or DTG

A very tolerable drug, but side effects may include insomnia, headache, fatigue, and hypersensitivity.


elvitegravir, or EVG

Most common side effects are nausea, diarrhea, headache, and fatigue. Elevated liver enzymes.


POTENTIAL DRUG CLASS SIDE EFFECTS: No class side effects known to date.


enfuvirtide, T-20, or ENF

Injection site reactions (ISRs) such as itching, pain/discomfort, or redness at site of injection; pneumonia; diarrhea; nausea; and fatigue. Hypersensitivity possible.


maraviroc, or MVC

The most common side effects include cough, fever, cold, rash, muscle and joint pain, stomach pain, dizziness, and trouble sleeping. Other side effects may include allergic reactions, liver toxicity, and heart problems in those with a history of heart disease. Rarely, dizziness or fainting when standing up due to low blood pressure. Possible increased risk of infections and cancer.


POTENTIAL DRUG CLASS SIDE EFFECTS: Because STRs contain a combination of medications from different drug classes, you should look up each drug contained in the pill.


efavirenz / emtricitabine / tenofovir

See Sustiva and Truvada (Emtriva and Viread). Diarrhea, nausea, fatigue, headache, dizziness, depression, insomnia, abnormal dreams, rash, and false positive test for marijuana. Risk of birth defects.


rilpivirine / emtricitabine / tenofovir

See Edurant and Truvada (Emtriva and Viread). Insomnia, headache, depressive disorders, and a slight increase in liver enzymes.


elvitegravir / cobicistat / emtricitabine / tenofovir

See Vitekta, Tybost, and Truvada (Emtiva and Viread). Nausea, diarrhea, headache, abnormal dreams, fatigue, increases in total cholesterol, bone problems, elevated liver function tests, and changes in kidney function tests.


dolutegravir / lamivudine / abacavir

See Tivicay, Epivir, and Ziagen. Most common side effects are insomnia, headache, and fatigue. A small increase in serum creatinine may be seen. Hypersensitivity and possibility of heart problems.


POTENTIAL DRUG CLASS SIDE EFFECTS: No class side effects known to date.


cobicistat, or COBI

Side effects seen in clinical studies include diarrhea, nausea, increases in cholesterol and triglycerides, red blood cells in the urine, and modest increase in serum creatinine (SCr) and decreased estimated creatinine clearance (CrCl).