Side Effects of ARVs

Some important ARV side effects to know about:

Rash and skin problems:

  • May go away, but may be a bad reaction if taking Nevirapine
  • You can:
    • Keep skin clean and dry
    • Only use mild soaps
    • Drink a lot of clean, boiled water to keep skin healthy
    • See the doctor or nurse if the itching is severe; the skin is peeling, looks infected (for example, has pus), is blistering or has open sores; if the client has a fever; or if the rash is in the eyes and mouth
    • If taking NVP, see the doctor or nurse right away if there is any kind of rash

Numbness or tingling feelings:

  • Can be caused by taking Stavudine or Didanosine, but also other ARVs and TB medicines or if there are other infections. Diabetes and drinking too much alcohol can also be the cause.
  • You can:
    • Wear loose socks and shoes to protect the feet
    • Check the feet to make sure there are no infections or open sores
    • Keep feet uncovered when in bed
    • Soak feet in warm water and massage them if this feels good
    • Keep feet up
    • Do not walk too much at one time and take breaks
    • Eat healthy foods and take multivitamins every day
    • See the doctor or nurse when numbness/tingling starts. There are some medications that may be able to help the symptoms.

Nausea and vomiting:

  • Usually go away in 2-4 weeks
  • You can:
    • Take medicines with food
    • Eat small meals more often
    • Eat crackers or dry bread
    • Chew on ginger or drink ginger tea
    • Stay away from fried or greasy and fatty foods
    • Stay away from very spicy foods
    • Drink a lot of clean, boiled water, weak tea and lemon water
    • Do not drink too much coffee or strong tea
    • Stop using traditional medicines that may be making things worse
    • See the doctor or nurse if there is fever, vomiting more than 3 times each day, inability to drink, stomach pains, dehydration or confusion


  • Usually go away in 2-4 week
  • You can:
    • Rest in a quiet, dark room
    • Put a cold cloth over the face and eyes
    • Stay away from strong tea and coffee
    • Take acetaminophen
    • See the doctor or nurse if it does not go away with acetaminophen or if there is fever, vomiting, blurry vision or convulsions


  • Usually goes away in 2-4 weeks
  • You can:
    • Not stop eating or drinking
    • Eat small meals during the day
    • Eat soft foods like rice and bananas
    • Stay away from spicy, greasy or fatty foods
    • Drink sips of clean, boiled water, weak tea, oral rehydration salts or lemon water
    • See the doctor or nurse if there is blood or mucous in the diarrhea, if there is fever, if diarrhea occurs more than 4-5 times in a day, if diarrhea occurs for more than 5 days in a row or if there are signs of dehydration (eyes are sunken, heart racing, mouth is dry, feeling lethargic/ weak, weight loss)

Cannot sleep or has nightmares:

  • Usually goes away in 2-4 weeks (most common with clients taking EFV)
  • You can:
    • Take ARVs at bedtime
    • Avoid heavy meals before going to sleep
    • Avoid drugs or alcohol
    • Avoid foods or drinks with sugar or caffeine before going to sleep
    • Talk about feelings and worries with your health care team, friends or family members
    • See the doctor or nurse if you are really depressed or suicidal


  • This is very common and can be caused by many things
  • You can:
    • Avoid alcohol and drugs
    • Do light physical activity, like taking a walk
    • Eat lots of fruits and vegetables and make sure to get enough iron
    • Take multivitamins
    • Try to get enough sleep at night and rest during the day if needed
    • See the doctor or nurse if they have a drug or alcohol problem or feel really depressed

Long-term side effects:

Many of the side effects people have when starting ART will go away over time. However, there are some long-term side effects that Peer Educators should be aware of.  These may include:

  • Changes in body shape – this is a long-term side effect that can be caused by ART, especially regimens with d4T. Some PLHIV may develop more fat on their stomach, breasts or other areas and lose fat in their face, arms and legs.
  • A build up of lactic acid in the body, which can cause weakness, nausea and other symptoms
  • Increased fat and sugar levels in the blood
  • Changes to different organs in the body (rare)

Clients should not stop taking their medications if they have side effects! The decision to stop or change ARVs should be made by the client and a health care worker together.

Serious Side Effects that Require Immediate Care at a Health Facility
Come to the clinic/nearest hospital right away if :
       Red rash that is getting worse
       Rash in the eyes or mouth
       Severe headache with stiff neck
       Numbness/tingling/burning in the hands and feet
       High fever that will not come down
       Vomiting for more than 3 days
       Diarrhea 5 times or more in a day, diarrhea for more than 5 days or if there is blood in the diarrhea
       Problems breathing
       Abdominal pain
       Dehydration or cannot drink
       Blurry vision
       Depression or thoughts of suicide
       A lot of confusion
        Seizures or convulsions


The Comprehensive Peer Educator Training Curriculum: Trainer Manual International Center for AIDS Care and Treatment Programs, Columbia Universit