22.4  ARV side-effects and how to manage them

Every drug can have side-effects, which means unwanted effects that result when taking the drug for treatment. ARV drugs can have multiple side-effects, some of which are common, and others which are rare. The most common side-effects of ARV drugs are shown in Table 22.2. You may need to advise patients when some of these occur, or refer them to a nearby health centre or hospital if serious side-effects arise.

Table 22.2  The most common side-effects of ARV drugs used in the first-line regimen.
Very common side-effects Potentially serious side-effectsSide-effects occurring later during treatment
ARV drug

Counsel patients about these and suggest ways they can manage them; also be prepared to help manage them when patients seek care at home.

Warn patients, and tell them to seek care urgently (or refer them urgently) if these occur.

Advise patients to seek care at a health centre or hospital.

Stavudine (d4T)
  • Nausea (the sensation of having an urge to vomit)
  • Diarrhoea
Refer urgently:
  • Severe abdominal pain;
  • Fatigue and shortness of breath.
Changes in fat distribution of the body:
  • Arms, legs, buttocks, cheeks become thin;
  • Breasts, belly, back of neck become fat.
Refer as soon as possible:
  • Tingling (a sensation of prickling), numbness (unable to feel, or loss of sensations), or painful feet, legs or hands.
Lamivudine (3TC)
  • Nausea
  • Diarrhoea.
Nevirapine (NVP)
  • Nausea
  • Diarrhoea.
Refer urgently:
  • Yellow eyes
  • Skin rash
  • Fatigue and shortness of breath
  • Fever.
Zidovudine (AZT or ZDV)
  • Nausea
  • Diarrhoea
  • Headache
  • Fatigue (a feeling of tiredness, or lack of energy)
  • Muscle pain.
Refer urgently:
  • Pallor (anaemia).
Efavirenz (EFV)
  • Nausea
  • Diarrhoea
  • Strange dreams
  • Difficulty sleeping
  • Memory problems
  • Headache
  • Dizziness (light-headed, feeling faint, unsteady, loss of balance).
Refer urgently:
  • Yellow eyes
  • Psychosis or confusion (Psychosis involves loss of contact with reality, usually with false beliefs about what is taking place or one’s own identity (delusions), and seeing or hearing things that aren't there (hallucinations). It is discussed in detail in the Module on Non-Communicable Diseases, Emergency Care and Mental Health).
  • Skin rash.

Note that side-effects such as nausea, vomiting and diarrhoea are very common with many ARV drugs, especially in the first 2–3 weeks of treatment. If a patient has nausea, you should advise him/her to take the tablets with food (or just after eating food). Patients who develop diarrhoea should be advised to drink more fluids, including oral rehydration salts, eat small and frequent meals, and avoid spicy foods. If the nausea, vomiting or diarrhoea worsens, the patient should be referred to a health centre or hospital as soon as possible.

22.3.3  How are antiretroviral drugs combined?

Summary of Study Session 22