What health practitioners need to know about ARV side effects

If you are a health practitioner working on HIV, the chances are you will have to deal with patients’ concerns about ARV side effects. Many of these concerns are based on misunderstandings. Below, we debunk the most common myths and give you the facts so you can help your patients stay on antiretroviral treatment (ART).

Myth 1: ARVs are poison – you will get sick if you take them

People with HIV need to take ARVs to protect their health, and although some people will get side effects these are likely to be temporary, mild and manageable. The most common side effects are:

• feeling sick
• diarrhoea
• tiredness
• having a rash. 

These symptoms are likely to go after a few weeks of starting ART. Anti-diarrhoea and anti-nausea tablets can help ease some of these symptoms in the meantime. 

Because these symptoms could be a sign of an infection, rather than an ARV side effect, it is important to monitor someone if they feel unwell after starting ART.

In rare cases (around 5% of people), the ARVs nevirapine, efavirenz and abacavir can cause a more serious rash (any rash that breaks the skin or covers more than 10% of the body). If this happens, switching ARVs is likely to resolve the issue.

Myth 2: ARVs make you put on weight 

It is true that some ARVs cause some people to gain or lose weight. But this change is usually so small it is not a reason to worry. 

If someone’s viral load was high when they first started treatment, they will naturally gain weight on ART. Some patients worry this is a side effect, but it is actually a sign of their body getting healthier.

It is important to record a patient’s weight when they start ART so you can monitor it. If someone experiences significant weight change you can help them to manage it, either through diet and exercise or, in rarer cases, by changing treatment. 

Myth 3: ARVs cause disfigurement

When HIV treatment first began, some ARVs caused lipodystrophy. This is when someone loses fat in their face, arms or legs and/or gains fat in their stomach, breasts or at the back of the neck. But modern ARVs do not cause lipodystrophy, so this is not something people need to worry about.

Myth 4: ARVs give you mood swings and poor sleep

It is unlikely that modern ARVs will cause anxiety, depression or sleep disturbances, such as insomnia or nightmares. They were commonly reported with the ARV efavirenz. But efavirenz is not often prescribed as a first-line treatment anymore. 

Dolutegravir is more commonly prescribed now. Only 5% of people on dolutegravir are likely to report changes to their mood or sleep from taking it. If a patient is experiencing insomnia, taking ARVs in the morning rather than the evening can help. 

It is important to be aware of the link between efavirenz and mental health issues if a patient starts an ART combination that includes this drug. 

Whatever regimen someone is on, they should feel able to talk openly with you about how they are feeling. If sleep and mental health issues persist, it might be time to explore a different type of ART.

Myth 5: ARVs give you liver and heart problems 

It is rare for modern ARVs to cause liver problems. If someone on ART has a liver issue it is more likely to be caused by another condition, such as viral hepatitis or alcohol dependency. It is true that the ARVs darunavir, atazanavir and lopinavir can raise blood fats in some people, which is linked to heart disease. But these ARVs are not commonly prescribed, meaning the risk of heart disease is low.

Blood fat levels should be checked as part of ART monitoring. If blood fats increase, diet, exercise or medication can usually reduce levels back to normal. If symptoms persist, switching to an alternative ART regimen can help.

Communication is key 

If someone gets ARV side effects that won’t go, switching to a different regimen normally solves the issue. That’s why it’s important that patients feel able to discuss their physical and mental health with you, so you can monitor and support them – and advise them if they might need to switch regimens.

Keeping up to date on developments in HIV treatment is also essential for providing good quality care. BITK’s HIV treatment resources offer guidance on supporting adherence and managing side effects. While our news section covers the latest in HIV treatment research. This HIV treatment manual from i-base is also a useful resource on ARV side effects.