References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Modern HIV treatment is much better tolerated than the drugs used in the 1990s and 2000s. Most people experience few or no side effects, and those that do occur are usually mild and settle within the first few weeks. Understanding what’s possible helps you know what’s normal, what’s not, and when to talk to your clinic.
Here’s a practical guide to the most common side effects and how to manage them.
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Common Early Side Effects
These are most likely in the first 2-4 weeks of starting or switching treatment and usually settle on their own:
| Side Effect | How Common | Usually Settles? |
|---|---|---|
| Nausea | Common | Yes, within 2-4 weeks |
| Headache | Common | Yes |
| Fatigue | Common | Yes |
| Diarrhoea | Common (especially PIs) | Often, but can persist with some drugs |
| Vivid dreams or insomnia | Moderate | Often improves |
| Dizziness | Uncommon | Usually |
Longer-Term Considerations
Weight gain
Associated with integrase inhibitors (dolutegravir, bictegravir) and TAF-containing regimens. Partly a return-to-health effect, partly drug-related. Managing diet and exercise helps.
Cholesterol and lipid changes
Some drugs, particularly protease inhibitors, can raise cholesterol and triglycerides. Monitored with regular blood tests.
Kidney function
Tenofovir DF (TDF) can affect kidney tubular function. Modern TAF formulations have less kidney impact. Monitored routinely.
Bone density
TDF can reduce bone mineral density slightly. TAF has less bone effect. Important for people with existing osteoporosis risk.
Mood and mental health
Efavirenz was known for mood changes and vivid dreams. Modern drugs cause fewer neuropsychiatric effects, but some people notice mood changes on dolutegravir.
When to Contact Your Clinic
- Rash — especially if widespread, blistering, or with fever or mouth sores
- Severe abdominal pain
- Yellowing of the skin or eyes (jaundice)
- Dark urine
- Persistent nausea or vomiting beyond 4 weeks
- Significant mood changes, depression or suicidal thoughts
- Signs of allergic reaction
What You Can Do
- Take your medication with food if nausea is an issue
- Take evening doses to sleep through side effects
- Stay hydrated
- Keep a brief symptom diary to discuss with your clinic
- Ask about switching — there are many alternative regimens available
- Never stop treatment without talking to your HIV team first
Read more: Biktarvy | Dovato | Feeling sick after meds
Frequently Asked Questions
Will I always have side effects?
Most people have few or no lasting side effects on modern treatment. If something bothers you, your clinic can often switch to a better-tolerated option.
Can I switch drugs to avoid side effects?
Yes. There are many effective regimens available. Your HIV team can find one that works for you without unwanted effects.
Are modern HIV drugs safer than older ones?
Yes. Today’s first-line drugs have far fewer side effects than those used 10-20 years ago. The improvements have been dramatic.
Related reading
- Injectable HIV Treatment: Everything You Need to Know
- Are HIV Tests Accurate If You're on PrEP, PEP or ART?
- CD4/CD8 Ratio: What It Means and Why It Matters
- CD4 Counts Explained: What Your Numbers Mean
- Changing HIV Treatment: When, Why and How
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
