ARV Adverse Effects & Drug Classes

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

NRTIs

Drug	Adverse Effect(s)
3TC
FTC
TDF⁽ⁱ⁾	Hepatitis ↓ BMD Osteomalacia ↑ Fractures risk ↓ eGFR Fanconi syndrome
TAF⁽ⁱ⁾	Weight gain
ABC	Rash Nausea* Diarrhoea* Coronary heart disease Systemic hypersensitivity syndrome (HLA B57:01 dependent)
ZDV⁽ⁱⁱ⁾	Nail pigmentation Nausea Steatosis Myopathy Rhabdomyolysis Lipoatrophy Dyslipidaemia Hyperlactataemia Anaemia

* Refers to effects seen in relation to hypersensitivity reactions

Drug	Adverse Effect(s)
EFV	Rash Hepatitis Neuropsychiatric events including: depression, sleep disturbance, headache Dyslipidaemia Gynaecomastia ↓ Plasma 25 (OH) vitamin D
RPV	Rash Hepatitis ↓ eGFR⁽ⁱⁱⁱ⁾ Depression Sleep disturbance Headache
DOR	Sleep disturbance Headache
ETV	Rash
NVP	Rash* Hepatitis* *Systemic hypersensitivity (CD4 count and gender dependent)

* Refers to effects seen in relation to hypersensitivity reactions

Drug	Adverse Effect(s)
DRV^(iv)	Rash Nausea and Diarrhoea^(v)Coronary heart disease Nephrolithiasis Dyslipidaemia
ATV^(iv)	Nausea and Diarrhoea^(v) Hyperbilirubinaemia Jaundice Cholelithiasis ↓ eGFR Nephrolithiasis Dyslipidaemia
LPV	Nausea and Diarrhoea^(v)IHD ↓ eGFR Dyslipidaemia

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

Drug

Adverse Effect(s)

RTV

Nausea and diarrhoea
↓ eGFR⁽ⁱⁱⁱ⁾
Dyslipidaemia

COBI

Nausea and diarrhoea
↓ eGFR⁽ⁱⁱⁱ⁾Dyslipidaemia

Drug	Adverse Effect(s)
DTG	Rash Nausea ↓ eGFR⁽ⁱⁱⁱ⁾ Sleep disturbance Headache Weight gain Systemic hypersensitivity syndrome (<1%)
BIC	↓ eGFR⁽ⁱⁱⁱ⁾ Sleep disturbance Headache Weight gain
CAB	Injection site reactions^(vi)Sleep disturbance HeadachePyrexia^(vii)
EVG/c	Nausea Diarrhoea ↓ eGFR⁽ⁱⁱⁱ⁾ Sleep disturbance Headache Weight gain
RAL	Nausea Myopathy Rhabdomyolysis Sleep disturbance Headache Weight gain Systemic hypersensitivity syndrome^(viii)

Drug	Adverse Effect(s)
LEN	Injection site reactions
MVC	Hepatitis Postural hypotension
Ibalizumab	Rash Nausea Diarrhoea Dizziness Headache
FTR	Rash Nausea Vomiting Abdominal pain Diarrhoea Headache
ENF	Injection site reactions Hypersensitivity

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 Diagnosis, Kidney Disease: Definition, Diagnosis and Management, ARV-associated Nephrotoxicity, Weight gain and Obesity
Still available, but generally not recommended due to toxicity
Due to inhibition of renal tubular creatinine secretion without affecting glomerular filtration itself
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). Coronary heart disease reported with ritonavir-boosted DRV only (no data with COBI-boosted DRV, although lipid effects lower)
Frequency and severity differs between individual PIs
CAB is available in oral or injectable formulations; injection site reactions are an adverse effect of injectable CAB
Pyrexia includes feeling hot or body temperature increased
DRESS syndrome reported in a few cases, potentially associated to HLA-B*53

* Refers to effects seen in relation to hypersensitivity reactions

Notes:

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
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