This section of the booklet provides some more information on the most common 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:

• HIV treatment might not be the cause of the side-effects. Many symptoms, for example headaches, diarrhoea, feeling or being sick and rashes can have causes other than anti-HIV drugs.
• 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. Talk to your doctor if side-effects are affecting the quality of your life. NAM's online tool, the Side-effects checker, can help you with this. It is an accepted reason for the need to think about changing the treatment you are on.

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.

Drinks with caffeine, such as coffee, and fatty and spicy food can make diarrhoea worse. However, changes in diet have little effect on drug-related diarrhoea. There are a variety of treatments 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. Diarrhoea can cause you to lose large amounts of salts and water from your body, so it is important to drink plenty of fluids. Eating soup can help with this. 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.

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

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.

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 can help reduce diarrhoea. Eating small, light meals can be a good way to get enough to eat.

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.

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. Try to eat when you are feeling least sick.
• Eat slowly.
• 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 and replace lost salts. Carry a packet with you when you leave the house.
• Rest after eating, but don’t lie flat.
• Eat food cold or at room temperature – the smells from 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. Painkillers 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.

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 be 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 NAM’s booklet HIV, mental health & emotional wellbeing.

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 an 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.

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.

If you do develop sexual problems, 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.

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

There could be other medical causes for erectile dysfunction in men, 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. 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 lopinavir/ritonavir, atazanavir or boosted darunavir or elvitegravir, your prescribed dose of an erectile dysfunction drug will be reduced. 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 (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.