ARV Adverse Effects & Drug Classes

  • Frequent effects (events expected in at least 10% of treated PLWH)(bold-black)
  • Severe effects (events that can put a person's life at risk and represent a medical emergency)(red)
  • Neither frequent nor severe effects (black)

NRTIs

Drug Adverse effect(s)

ABC

Rash
Nausea*
Diarrhoea*
IHD
*Systemic hypersensitivity syndrome (HLA B*57:01 dependent)

ZDV(ii)

Nail pigmentation
Nausea
Steatosis
Myopathy
Rhabdomyolysis
Lipoatrophy
Dyslipidaemia
Hyperlactataemia
Anaemia

3TC  
FTC  
TDF(iii) Hepatitis
↓ BMD
Osteomalacia
↑ Fractures risk
eGFR
Fanconi syndrome
TAF(iii)

Weight gain

 

* Refers to effects seen in relation to hypersensitivity reactions

NNRTIs

Drug Adverse effects(s)
EFV

Rash
Hepatitis
Neuropsychiatric events including:
depression, s
leep disturbance, headache
Dyslipidaemia
Gynaecomastia
Plasma 25 (OH) vitamin D

ETV

Rash

NVP Rash*
Hepatitis*
*Systemic hypersensitivity (CD4 count and gender dependent)
RPV

Rash
Hepatitis
↓ eGFR(iv)
Depression
Sleep disturbance
Headache

DOR Sleep disturbance
Headache 

 

* Refers to effects seen in relation to hypersensitivity reactions

PIs

Drug

Adverse Effect(s)

ATV(v)

Nausea and Diarrhoea(vii)
Hyperbilirubinaemia
Jaundice
Cholelithiasis
↓ eGFR
Nephrolithiasis
Dyslipidaemia

DRV(v) Rash
Nausea and Diarrhoea(vii)
IHD
Nephrolithiasis
Dyslipidaemia
LPV Nausea and Diarrhoea(vii)
IHD
↓ eGFR
Dyslipidaemia

Boosting

Drug Adverse Effect(s)
RTV Nausea and diarrhoea
↓ eGFR(iv)
Dyslipidaemia
COBI

Nausea and diarrhoea
↓ eGFR(iv)
Dyslipidaemia

INSTI

Drug Side effect(s)
RAL Nausea
Myopathy 
Rhabdomyolysis
Sleep disturbance
Headache
Weight gain
Systemic hypersensitivity syndrome(viii)
DTG

Rash
Nausea
eGFR(iv) 
Sleep disturbance
Headache
Weight gain

Systemic hypersensitivity syndrome (<1%)
↑ Risk of neural tube defects (pre-conception)(ix)

EVG/c

Nausea
Diarrhoea
↓ eGFR(iv)
Sleep disturbance
Headache 
Weight gain

BIC

↓ eGFR(iv)
Sleep disturbance
Headache 
Weight gain

CAB

Injection site reactions(x)
Sleep disturbance
Headache 
Pyrexia(xi)

Entry inhibitors

Drug Side effect(s)
Ibalizumab

Rash
Nausea
Diarrhoea
Dizziness
Headache

FTR

Rash
Nausea
Vomiting
Abdominal pain
Diarrhoea
Headache

MVC Hepatitis
Postural hypotension
ENF

Injection site nodules
Hypersensitivity

 

  1. "Frequent effects" (events expected in at least 10% of treated PLWH), in bold
    "Severe effects" (events that can put a person's life at risk and represent a medical emergency), in red
    "Neither frequent nor severe effects", in non-bold black
  2. Still available, but generally not recommended due to toxicity
  3. TDF and TAF are prodrugs of tenofovir. TDF, but not TAF, may have kidney and bone toxicity particularly when co-administered with RTV or COBI boosting. TDF, but not TAF, decreases plasma lipids. TAF, but not TDF, may promote weight gain particularly when co-administered with DTG or BIC, see Bone Disease: Screening and DiagnosisKidney Disease: Definition, Diagnosis and ManagementARV-associated Nephrotoxicity, Weight gain and Obesity
  4. Due to inhibition of renal tubular creatinine secretion without affecting glomerular filtration itself
  5. ATV can be used unboosted or boosted with low-dose RTV or COBI ATV-related adverse effects are more common with boosting. DRV can be used boosted with low-dose RTV or COBI. Both low-dose RTV and COBI as boosters may cause minor digestive problems and lipid increases (low-dose RTV more than COBI). IHD reported with ritonavir-boosted DRV only (no data with COBI-boosted DRV, although lipid effects lower)
  6. Still available but seldom used. Requires RTV-boosting
  7. Frequency and severity differs between individual PIs
  8. DRESS syndrome reported in a few cases, potentially associated to HLA-B*53
  9. See Treatment of Pregnant Women or Women considering Pregnancy
  10. CAB is available in oral or injectable formulations; injection site reactions are an adverse effect of injectable CAB
  11. Pyrexia includes feeling hot or body temperature increased

    * Refers to effects seen in relation to hypersensitivity reactions


Notes:

  1. The adverse effects listed in the table above are not exhaustive, but represent the most important effects with a likely causal relation. Nausea, diarrhoea and rash are frequently observed in persons on ART, and these symptoms are indicated in the table for drugs where clinical experience suggests a possible causal link
  2. D4T, ddI, FPV, IDV, SQV and TPR removed. Please refer to EACS v9.1 for details, http://www.eacsociety.org/files/2018_guidelines-9.1-english.pdf