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Human immunodeficiency virus or HIV is a virus that makes your immune system so weak that it becomes hard for it to fight off even minor illnesses. That’s why people affected by this virus get infections and fall ill easily. If the virus starts attacking your immune system, and you don’t go for treatment on time, it can progress to acquired immunodeficiency syndrome or AIDS, which is a chronic condition. There are HIV medicines, which can improve the quality of life. However, there are also side effects of HIV drugs. Know all about their adverse effects on World AIDS Vaccine Day, also known as HIV Vaccine Awareness Day, observed on May 18.
Human immunodeficiency virus is a virus that specifically targets the immune system. “It attacks and gradually destroys CD4 cells (also known as T-helper cells), which are essential for fighting off infections and diseases,” says internal medicine and infectious diseases expert Dr Ankit Bansal. The virus is usually transmitted through specific body fluids like blood, semen, vaginal and rectal fluids, and breast milk.
It remains a major health concern, as it has taken lives of approximately 42.3 million people, according to the World Health Organization. Over time, if HIV is not treated, it can lead to AIDS, a condition in which the immune system becomes severely weakened.
There is no HIV vaccine approved by the US Food and Drug Administration. However, recently two HIV vaccine trials were conducted in the US and Africa. A study, based on those trials and published in Science in May 2025, found that the vaccines were generally safe and well tolerated. Only 18 percent of the participants experienced skin reactions.
Symptoms vary depending on the stage of infection:
Antiretroviral drugs (ARVs) are medications that treat HIV by blocking different stages of the virus’ life cycle, preventing it from multiplying in the body. “ARVs don’t cure HIV but help reduce the viral load, improve immune function, and prevent transmission,” says Dr Bansal.
Different classes of ARVs include:
“Combination therapy (3 or more drugs) is the standard approach to reduce resistance and ensure effective viral suppression in people with HIV,” says the expert.
They may help to relieve symptoms of HIV, but they are side effects of HIV drugs:
“Many ARVs are metabolised in the liver or gastrointestinal tract, and some irritate the stomach lining,” says the expert. They can alter the chemical signals in the brain’s vomiting center (chemoreceptor trigger zone), especially early in treatment when the body is still adjusting to the new medications.
Sometimes, ARVs affect the gut lining or alter the balance of normal gut bacteria. This leads to increased water secretion into the intestines or decreased absorption, causing loose stools, one of the side effects of HIV drugs. Diarrhea may also result from mild inflammation of the intestinal lining.
Fatigue, one of the side effects of HIV drugs, can be caused by mitochondrial toxicity, where ARVs (especially older NRTIs like zidovudine) damage energy-producing components in cells. “The immune system’s response to HIV and the emotional toll of living with a chronic illness also contribute to persistent tiredness,” says the expert.
Rashes are typically due to hypersensitivity (allergic) reactions to the drugs. The immune system sees the medication as a threat, and so, triggers inflammation in the skin. Some rashes can be severe, like Stevens-Johnson Syndrome, which can also cause your skin to develop blisters and then peel.
The liver processes most ARVs, making liver toxicity one of the side effects of HIV drugs. Certain drugs can cause an overload or toxic buildup in liver cells, leading to inflammation or liver enzyme elevations. “People with pre-existing liver disease (like hepatitis B or C) are more vulnerable,” says the expert.
Some of the HIV Drugs like tenofovir disoproxil fumarate can damage tiny filtering units in the kidneys, affecting their ability to remove waste. This can lead to a decline in kidney function, especially in long-term use. One of the long-term side effects of HIV drugs is kidney failure, according to research published in StatPearls.
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“Some ARVs, particularly efavirenz, can cross the blood-brain barrier and affect neurotransmitters in the brain,” says Dr Bansal. This may lead to insomnia, anxiety, depression, or even hallucinations in some cases.
Here’s what you can do to prevent the side effects of HIV drugs:
HIV drugs can help to manage the condition, and help people living with the virus to lead healthy lives. Yes, there are side effects of HIV drugs, but can be effectively managed with regular follow-ups and a few modifications.
Yes, with consistent use of ART and a healthy lifestyle, individuals living with HIV can enjoy a life expectancy comparable to those without the virus. Early diagnosis and adherence to treatment are important.
Skin-related effects of HIV and its treatment include drug-Induced rashes, dark patches, especially on the face, hands, or feet, and dry skin. Moisturising skin and sun protection are needed.
Since their immunity is affected, people with HIV should avoid raw foods, unpasteurised milk and exposure to contaminated water. They should also avoid drinking in excess, as it can interfere with HIV drugs.
There is no cure, but sticking to antiretroviral therapy can prevent complications. There is no effective vaccine for it.
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