Side Effects Of Antiretroviral Medications

  • Samuel Green MNeuro, Neuroscience, University of Southampton
  • Regina LopesJunior Editor, Centre of Excellence, Health and Social Care, The Open University

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative

Introduction

Antiretroviral medications (or ARTs – antiretroviral therapies) are a series of drugs used to treat HIV (Human Immunodeficiency Virus). HIV is an infection which destroys the immune cells (specifically certain white blood cells). Having fewer immune cells leaves the individual more vulnerable to other infectious agents such as bacteria or other viruses. These infections, which may not be concerning amongst normal people, can be fatal to those with HIV.1

It is important to note that there is currently no cure for HIV, antiretroviral drugs only manage the disease. These drugs work by reducing the amount of virus inside the body so that the immunity of the individual is not compromised. It is called an ‘antiretroviral’ drug as the HIV pathogen is a ‘retrovirus’. This means that the virus uses RNA as its genetic material, instead of the DNA that we use. Once the RNA is inside the host cell it is converted into DNA and the cell begins to make more retrovirus, which travel to other cells to spread the infection.2

Purpose and effectiveness of antiretrovirals

Antiretroviral drugs cannot cure HIV but instead work to reduce the amount of virus (or viral load) in the body. ARTs do this by preventing the replication of the virus within the immune cells. Having a lower viral load means that the body will have more functioning white blood cells, giving us a much better defence against other pathogens. Having a lower viral load also reduces the risk of transmitting the infections to other people. The goal of these medications is to achieve an ‘undetectable viral load’. This means that the number of viruses in the blood is so low that the risk of transmitting the disease to a sexual partner is near zero.3 

Common antiretroviral medications

Antiretroviral medications work by preventing the replication of the virus within the host cell. There are many ways this can be done, so there are different classes of drugs available. We will look at the four main types of drugs and how they work.

Nucleoside reverse transcriptase inhibitors (NRTIs)

NRTIswork by interrupting a process known as ‘reverse transcription’. Once inside the host cell, viruses use reverse transcription to convert their RNA into DNA, allowing them to replicate. By stopping this process, the virus is unable to replicate. This class of drug is often known as the backbone of HIV therapy and is usually the first-line treatment. 

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

This class of drugs acts in a similar fashion to NRTIs, but rather than interrupting the formation of DNA, they directly bind to and disrupt the action of the enzyme responsible for making viral DNA. 

Protease inhibitors (PIs)

PIs target an enzyme known as protease. Viruses use this enzyme to break down larger molecules into smaller pieces when assembling new viral bodies. While inhibiting a protease will not stop new viruses from being made, the resulting viruses are immature and are not able to infect other cells, making them useless.

Integrase inhibitors (INSTIs)

This class of drugs targets an enzyme known as integrase. Viruses use this molecule to insert their newly formed viral DNA into the DNA of the host cell, allowing it to replicate. By preventing this, the virus cannot use the host DNA to make more copies of itself.4

To treat HIV a combination of these drugs are often given to patients to better tackle the disease. Following the advice of medical professionals and strictly adhering to therapy can prolong lifespan, improve quality of life and provide a positive outlook on survival while living with HIV. 

Side effects of antiretroviral medications

While undertaking therapy with antiretroviral drugs, there are some side effects that patients might experience. Generally the benefits these drugs provide outweigh the unpleasant side effects, but some people may experience more serious complications. The effects that each drug has on an individual can vary in type and severity. However, as further advancements are made in the field of antiretroviral drugs, people are expected to feel fewer and less severe side effects. Typical side effects can be either short or long-term.5

Short-term side effects

The main short-term side effects include

  • Gastrointestinal issues e.g. bloating, nausea and diarrhoea
  • Fatigue
  • Headaches

Long-term side effects

Long-term side effects include increases in cholesterol, leading to further complications like cardiovascular problems e.g. clogged arteries and coronary artery disease. Antiretroviral drugs have also been found to cause high blood sugar, which can lead to further complications, especially if the patient already has diabetes.

Immune reconstitution inflammatory syndrome (IRIS)

Around 30% of HIV patients who are started on antiretroviral drugs may experience IRIS. It is described as a state of excessive inflammatory response from the body due to an infection. Before treatment is started an individual may already have contracted an infection. As their immune cells are low the body is not able to fight against it and they may not feel any significant symptoms for some time. If antiretroviral therapy is started and the immune system detects this infection it can result in a much larger reaction than normal. This includes severe fever and body pains. The risk of this is reduced by screening for infections before starting antiretroviral drugs.7

Drug interactions

Antiretroviral drugs may cause side effects depending on other medications that the individual is taking. These ‘drug-drug interactions’ can have many effects. Some interactions can lead to one drug having a much larger effect than normal. For example, taking morphine with an ART can result in a greater level of morphine in the blood, leading to respiratory side effects. 

On the other hand, mixing drugs can reduce their function, such as anti-epileptic medications which can inhibit the actions of NRTIs. Other drugs can also cause side effects that affect the heart and other organs. It is important to inform your doctor about any other medical conditions and relevant medications that you take so that they can fully assess which antiretroviral drug is right for you.6

Strategies for managing side effects

Most of the milder side effects can be managed with simple medications such as pain relievers or diarrhoea medication. Some side effects may reduce over time as the body adapts to the sudden change and the immune system recovers. Despite this, dealing with some of these side effects can be very difficult and may lead to impaired mood and mental health. If you are experiencing any difficulties with taking ART it is important that you communicate this with your doctor, but do not stop the medications yourself unless advised to do so by a medical professional. 

Some people take their medications at certain times of the day to avoid feeling side effects at inappropriate times. For example, patients may take medication 2 hours before sleeping to avoid feeling drowsy during the day. Others choose to take it in the morning as they find that the medications interfere with their sleep quality.6 

Summary

Antiretroviral therapy is the best course of treatment for HIV, allowing people to lead almost normal lives as a result. The medications are not a cure but help to reduce the viral load by preventing the virus from replicating within cells through various mechanisms. While these drugs are effective they can be associated with side effects.

Some of these can be mild such as headaches and diarrhoea, while others may experience more severe effects such as IRIS or severe interactions with other medications that they take. It is important to discuss past medical history with your doctor and share any side effects that you are feeling so that they can advise you on how to best tackle them.

References

  1. Cleveland Clinic [Internet]. [cited 2024 Jan 8]. What is antiretroviral therapy? Available from: https://my.clevelandclinic.org/health/treatments/antiretroviral-therapy
  2. Retrovirus [Internet]. [cited 2024 Jan 8]. Available from: https://www.genome.gov/genetics-glossary/Retrovirus
  3. Hiv treatment: the basics | nih [Internet]. [cited 2024 Jan 8]. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-basics
  4. aidsmap.com [Internet]. 2021 [cited 2024 Jan 8]. Types of antiretroviral medications. Available from: https://www.aidsmap.com/about-hiv/types-antiretroviral-medications
  5. Hiv medicines and side effects | nih [Internet]. [cited 2024 Jan 8]. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-medicines-and-side-effects
  6. Montessori V, Press N, Harris M, Akagi L, Montaner JSG. Adverse effects of antiretroviral therapy for HIV infection. CMAJ [Internet]. 2004 Jan 20 [cited 2024 Jan 8];170(2):229–38. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC315530/
  7. Thapa S, Shrestha U. Immune reconstitution inflammatory syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2024 Jan 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK567803/
  8. Side effects | Terrence Higgins trusts [Internet]. [cited 2024 Jan 8]. Available from: https://www.tht.org.uk/hiv-and-sexual-health/living-well-hiv/hiv-treatment/side-effects

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative
[optin-monster-inline slug="yw0fgpzdy6fjeb0bbekx"]
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

Get our health newsletter

Get daily health and wellness advice from our medical team.
Your privacy is important to us. Any information you provide to this website may be placed by us on our servers. If you do not agree do not provide the information.

Leave a Reply

Your email address will not be published. Required fields are marked *

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
Email:
Klarity / Managed Self Ltd
Alum House
5 Alum Chine Road
Westbourne Bournemouth BH4 8DT
VAT Number: 362 5758 74
Company Number: 10696687

Phone Number:

 +44 20 3239 9818