Dealing with side-effects

One of the frequently cited benefits of deferring antiretroviral therapy is the avoidance of drug-related side-effects . 

While waiting longer to start treatment can indeed delay side-effects, there is also evidence that people who start treatment with more advanced disease tend to experience more frequent and more severe side-effects.

Researchers studying the HOPS cohort in the United States, for example, reported that people with a pre-treatment CD4 cell count below 200 cells/mm3 were more likely to experience side-effects caused by nucleoside reverse transcriptase inhibitors (NRTIs), including anaemia, peripheral neuropathy and kidney dysfunction.1 However, an earlier analysis of the Italian ICONA cohort found no significant relationship between pre-treatment CD4 cell count and the likelihood of stopping therapy due to drug toxicity.2

With the dramatic decline in illness and death due to opportunistic infections in the late 1990s, attention soon turned to long-term metabolic toxicities associated with antiretroviral treatment. Numerous studies have shown a link between antiretroviral drugs - in particular protease inhibitors - and metabolic abnormalities including lipodystrophy (body fat changes), elevated blood lipids (cholesterol and triglycerides) and blood sugar abnormalities like insulin resistance. However, it remains unclear whether chronic conditions such as cardiovascular disease in people with HIV are primarily due to the drugs or traditional risk factors such as older age and smoking.

Concern about side-effects has led many patients to delay starting treatment, and has also prompted researchers to study whether minimising time on HIV therapy might reduce the occurrence of drug-related toxicities. At the outset of the SMART trial, the investigators expected that periodic treatment breaks would reduce the risk of long-term toxicities associated with antiretroviral therapy. However, compared with patients who stayed on continuous therapy, those who interrupted treatment actually had a higher rate of cardiovascular, kidney and liver problems, which are often assumed to be treatment side-effects.3


  1. Lichtenstein K et al. Initiation of antiretroviral therapy at higher CD4+ T cell counts reduces incidence of nucleoside analogue toxicities acutely and risk for later development with continued use of these agents in the HIV outpatient (HOPS) cohort. 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention, Sydney, abstract MOPEB016, 2007
  2. Cozzi-Lepri A et al. When to start HAART in chronically HIV infected patients? Evidence from the ICONA study. AIDS 15: 983-990, 2001
  3. Strategies for Management of Antiretroviral Therapy (SMART) Study Group. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 355: 2283-2296, 2006
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.