Merck Manual

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Drugs for HIV Infection

Drugs for HIV Infection


Some Side Effects†

Attachment inhibitor


Nausea and vomiting

Possible elevations in liver enzymes in patients with hepatitis B or C virus

Entry (fusion) inhibitors

Enfuvirtide (T-20)

Painful rash at the injection site and allergic (hypersensitivity) reactions (including rash, fever, chills, nausea, and low blood pressure), numbness and tingling in the hands and feet (peripheral neuropathy), insomnia, and loss of appetite

Increased risk of pneumonia

Maraviroc (a CCR-5 inhibitor)

Inadequate blood flow (ischemia) to the heart or heart attacks

Post-attachment inhibitors


Diarrhea, tiredness, and dizziness

Integrase inhibitors


Allergic (hypersensitivity) reactions including rash (which is occasionally severe or life threatening), headache, insomnia, and muscle aches


Possible increased risk of fetal neural tube defects if used during early pregnancy


Nausea and diarrhea


Allergic (hypersensitivity) reactions including rash (which is occasionally severe or life threatening) and muscle aches

Non-nucleoside reverse transcriptase inhibitors

All of these drugs

Rash (occasionally severe or life threatening) and liver dysfunction


Fatigue, headache, dizziness, and rarely insomnia


Dizziness, sleepiness, nightmares, confusion, agitation, forgetfulness, and intense feelings of well-being (euphoria)


Severe or life-threatening rashes


Severe or life-threatening liver dysfunction and rashes, especially during the first 18 weeks of treatment


Depression, headache, and insomnia, but fewer side effects involving brain function than efavirenz

Nucleoside reverse transcriptase inhibitors

All of these drugs

Lactic acidosis (buildup of lactic acid, a waste product of metabolism), which can be life threatening, and liver damage

Abacavir (ABC)

A severe, sometimes fatal allergic reaction with fever, rash, nausea, vomiting, difficulty breathing, a sore throat, and/or cough

Loss of appetite, nausea, and vomiting

Emtricitabine (FTC)

Headache, nausea, diarrhea, and darkening of the skin (hyperpigmentation), especially on the palms and soles

Lamivudine (3TC)

Headache, fatigue, and peripheral nerve damage

Rarely, pancreas inflammation (pancreatitis)

Zidovudine (AZT or ZDV)

Anemia, susceptibility to infection (resulting from bone marrow damage), liver damage, weakness, and muscle aches

Rarely, pancreas inflammation

Nucleotide reverse transcriptase inhibitors

Tenofovir alafenamide fumarate (TAF)

Fewer side effects involving the kidneys and bone density than tenofovir disoproxil fumarate

Tenofovir disoproxil fumarate (TDF)

Kidney injury

Decreased bone density

Diarrhea, nausea, vomiting, and headache

Protease inhibitors‡

All of these drugs

Nausea, vomiting, diarrhea, abdominal discomfort, increased levels of blood sugar and cholesterol (common), increased abdominal fat, liver dysfunction, and a bleeding tendency (particularly in people with hemophilia)

Atazanavir (ATV)

Rash and yellowing of the skin and whites of the eyes (jaundice)


Liver injury

Headache, diarrhea, severe rash, fever, and allergic reactions



Lopinavir (LPV)

Mouth tingling and altered taste

Nelfinavir (NLF)


Tipranavir (TPV)

Possibly life-threatening liver inflammation and bleeding within the brain

*All drugs, except enfuvirtide, are taken by mouth. Enfuvirtide is injected under the skin.

† Side effects listed for the class of drug can occur when any drug in that class is used.

‡ All protease inhibitors are used with a booster of either low dose ritonavir or cobicistat.