How to Manage Side Effects of HIV Treatment
Updated on August 13, 2026
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Human immunodeficiency virus (HIV) treatment has advanced dramatically over the past few decades. Modern treatment, called antiretroviral therapy (ART), controls the virus effectively and is much easier on the body than older regimens. Yet side effects can still happen, especially in the first few weeks after starting a new medication. Taking your HIV medications consistently, every day, is essential for keeping the virus at bay, and you should not stop a medication without speaking to your healthcare provider first, even if you’re experiencing side effects.
“Side effects now are much more manageable than they were before,” says Raymond Alejo, community health nurse with the Hawai’i Health and Harm Reduction Center in Honolulu. And there are steps you can take to manage your side effects, rather than suffering in silence.
Short-Term Side Effects
Though they aren’t as significant as in the past, side effects are still common with HIV medications, says Dominic Chow, MD, PhD, a professor with the Hawai’i Center for AIDS and the University of Hawai’i Department of Medicine. “There are new ones [side effects] that pop up with new medications all the time,” he says. But they’re generally mild, and there are multiple things you can do to try to alleviate them. Many of these side effects resolve on their own after a few weeks, as your body adjusts to the new medication.
Nausea, Vomiting, and Loss of Appetite
Nausea is a common side effect of ART. Your nausea may worsen if you eat large meals, very hot or cold dishes, or foods that are greasy, spicy, sweet, or acidic. Instead, try eating smaller, more frequent meals that are bland and at room temperature. Additionally, ginger and peppermint may help calm your stomach troubles, while dry foods like crackers and toast are good options if you’re struggling to keep food down.
Smaller, more frequent meals can also help with poor appetite, and protein drinks can provide supplemental nutrients and calories.
If these dietary changes aren’t enough, ask your provider about prescription or over-the-counter (OTC) medications to help relieve nausea. You should also check whether you are taking your medications correctly, because some require an empty stomach while others need to be taken with food, Alejo says.
Diarrhea
The BRAT diet — bananas, rice, applesauce, and (white) toast — used to be frequently recommended for diarrhea because the foods are soft, bland, and low in insoluble fiber, making them easy on the GI tract. The restrictive diet lacks a lot of vital nutrients, however, so you shouldn’t follow it for more than a couple of days. Other foods you can add to balance the diet include oatmeal, boiled potatoes, and brothy soups.
Stay away from foods that can worsen your diarrhea, including:
- Spicy, fatty, starchy, and acidic foods
- Dairy products
- Raw or undercooked meat, fish, and poultry
- Caffeine and alcohol
- Foods that produce gas, like beans and broccoli
- Foods high in insoluble fiber, like whole grains, brown rice, and the skins of fruits and vegetables
Also make sure to stay hydrated as your body recovers from diarrhea.
Antidiarrheal medication options include OTC drugs like loperamide (Imodium) and the prescription drug crofelemer (Fulyzaq), which is specifically for patients on ART.
"Sometimes, taking a fiber supplement like Metamucil or psyllium husk, usually used for constipation, can help with diarrhea because it’s also a bulking agent,” Alejo says.
Fatigue
Fatigue is both a symptom of HIV and a side effect of HIV medications. Regardless of the cause of your fatigue, try walking; low-intensity exercises like jogging, swimming, or biking; or resistance exercises like weight lifting. But don’t push yourself to the point of breathlessness. Also, stay hydrated, eat well-balanced meals, and follow consistent sleep habits.
Headache
“I used to hear a lot of people complain of headaches with the earlier medications like lamivudine and AZT,” says Alejo, who’s been providing HIV services in Hawai’i for more than 25 years. “But not so much now.”
If you do experience headaches, OTC pain killers like aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve) are generally effective. You can also try massaging the base of your skull, placing a cold washcloth over your forehead and eyes, or resting in a quiet, dark room until the headache passes.
Weight Gain
Weight gain can be either a short-term side effect, as your body adjusts to a new medication, or a long-term side effect. If side effects have been a significant issue, your doctor may recommend trying long-acting, injectable ART, which belongs to a class of drugs called integrase inhibitors and is injected once every two weeks to six months, depending on the specific drug.
“These injectables have been a godsend,” Dr. Chow says, adding that, in his experience, they cause significantly fewer side effects. Clinical trials show that patients are more likely to discontinue daily ART due to side effects than long-acting ART.
But like other integrase inhibitors, the long-acting injectables can cause considerable weight gain, especially in Black people. “I’ve had a couple of my patients gain over 40 pounds,” Chow says. Speak with your provider if you experience weight gain — they may recommend that you try a different long-acting injectable, change your dietary and exercise habits, or use GLP-1 weight loss medications, he says.
Long-Term Side Effects
Some side effects of HIV medications are more serious, but they develop more gradually. You may not notice symptoms at first, and they are often only caught through routine blood work or checkups. They’re also generally associated with older HIV medications.
Long-term side effects include:
- Liver Damage Liver damage can occur and be detected by elevated levels of liver enzymes. This often doesn’t cause symptoms, but signs can include dark urine, clay-colored stool, and jaundice (yellowing of the skin and eyes).
- Kidney Problems Chronic kidney problems, including kidney disease, may develop from some tenofovir-based medications, causing symptoms like foamy or discolored urine and swelling in the hands, legs, or feet.
- Lipodystrophy This term describes changes in how the body stores fat, which can alter your body’s fat distribution, sometimes significantly. Changing your medications, diet, and exercise may help.
- Bone Thinning Some medications may speed up normal age-related bone loss, leading to osteoporosis or osteopenia. However, newer formulations don’t affect bones as much.
- Heart Disease Both HIV and certain HIV medications can increase the risk of heart disease, leading to potentially serious symptoms, including chest pain, shortness of breath, fatigue, and weakness.
When to Call Your Doctor
Most medication side effects decrease or completely subside within the first few weeks of starting a medication. But rare, serious complications are also possible and require immediate medical attention.
Call your healthcare provider if you experience:
- Nausea that affects your ability to eat and take medications
- Vomiting that lasts for more than a few days
- Diarrhea lasting five or more days
- Severe headache that comes with vision changes, dizziness, stiff neck, or fever
- A rash that blisters, involves the mouth, palms, or soles of the feet, or comes with shortness of breath, which may indicate a rare but serious skin reaction called Stevens-Johnson syndrome
- Heart disease symptoms, such as chest pain or shortness of breath
Resources We Trust
- Cleveland Clinic: Antiretroviral Therapy
- Mayo Clinic: HIV/AIDS: Diagnosis and Treatment
- HIVinfo.NIH.gov: HIV Medicines and Side Effects
- Clinical Info HIV.gov: Drug Database
- U.S. Food and Drug Administration: HIV and AIDS: Medicines to Help You
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Side Effects. The Well Project. June 27, 2025.
- Tips for Common Side Effects. U.S. Department of Veterans Affairs. September 11, 2020.
- Diarrhea. The Well Project. December 10, 2025.
- Why You Shouldn’t Follow a Strict BRAT Diet When You’re Sick. Cleveland Clinic. March 27, 2025.
- Crofelemer Delayed-Release Tablets. Cleveland Clinic.
- Managing Side Effects of HIV Medications. New York State Department of Health.
- Long-Acting HIV Medicine. HIVinfo.NIH.gov. April 17, 2026.
- Long-Acting Injectable Antiretroviral Therapy for HIV Management. Nature Index.
- Long-Acting HIV Treatment Benefits Adults With Barriers to Daily Pill Taking and Adolescents With Suppressed HIV. National Institutes of Health. March 6, 2024.
- Bourgi K et al. Weight Gain on Contemporary Integrase Strand Transfer Inhibitors and Tenofovir Alafenamide in Persons With HIV Starting Antiretroviral Therapy in the United States and Canada. The Journal of Infectious Diseases. May 29, 2026.
- Common and/or Severe Adverse Effects Associated With Antiretroviral Medications. Clinical Info HIV.gov.
- Froeber J. Questions and Answers About HIV and Bone Health. Healthy Women. March 11, 2026.
- Caring for Your Liver. The Well Project. October 27, 2025.
- Asirvatham ES et al. A Review of Tenofovir Disoproxil Fumarate Associated Nephrotoxicity Among People Living With HIV: Burden, Risk Factors and Solutions. Clinical Epidemiology and Global Health. November 22, 2023.
- Lipodystrophy and Body Changes. The Well Project. August 21, 2024.
- HIV and Heart Disease. HIVinfo.NIH.gov. March 31, 2025.
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