References: side effects and your quality of life

More than 400 references were used in preparing the information in this i-Base guide including at least 50 new references since the previous update.

Side effects and and your quality of life

Whenever possible, we used publications that are accessible free as open access online. Where this was not possible, we include links to the study abstract. Many publications provide free access to full text articles after 1–2 years of the publication date.

This is not a comprehensive list of sources and it will be updated as new studies are published. Some references have short notes on the specific reason we have included them. Many of these articles include 20-40 references of their own. These are a good pointer for further information.


British HIV Association guidelines: Treatment of HIV-1 positive adults with antiretroviral therapy (2015)

UK National Guideline for the Use of HIV Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE) 2015

European Guidelines for treatment of HIV-infected adults in Europe (EACS). Version 8.0, October 2015.

Hopkins HIV Guide (online management guide, requires one-time free registration).

British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals. (2011)

US guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. (July 2016)

Individual drugs. Summary or prescribing information for individual antiretroviral drugs. All available on EMA or FDA websites.

Quality of life

Briongos Figuero LS et al. Assessment of factors influencing health-related quality of life in HIV-infected patients. HIV Medicine, electronic publication ahead of print. Article first published online: 28 JUN 2010, DOI: 10.1111/j.1468-1293.2010.00844.x

Life expectancy

The Antiretroviral Therapy Cohort Collaboration Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. The Lancet, Volume 372:293-299., 26 July 2008

Lohse N et al. Survival of Persons with and without HIV Infection in Denmark, 1995-2005. Annals 2007 146: I-39.

Hill A et al. A normal life expectancy, despite HIV infection? AIDS: 19 June 2010 – Volume 24 – Issue 10 – p 1583-1584 doi: 10.1097/QAD.0b013e32833ac7d4.,_despite_HIV_infection_.21.aspx

Reporting side effects

MHRA: What is the Yellow Card Scheme?

Side effects and adherence

Ammassari A et al. Self-Reported Symptoms and Medication Side Effects Influence Adherence to Highly Active Antiretroviral Therapy in Persons With HIV Infection. JAIDS: 15 December 2001 – Volume 28 – Issue 5 – pp 445-449.

Attaran A. Adherence to HAART: Africans take medicines more faithfully than North Americans. PLoS Med. 2007 Feb;4(2):e83. doi: 10.1371/journal.pmed.0040083.

Duran S et al. Failure to maintain long-term adherence to highly active antiretroviral therapy: the role of lipodystrophy. AIDS: 7 December 2001 – Volume 15 – Issue 18 – pp 2441-2444.

Protopopescu C et al. Prolonged viral suppression over a 12-year follow-up of HIV-infected patients: the persistent impact of adherence at 4 months after initiation of combined antiretroviral therapy in the ANRS CO8 APROCO-COPILOTE cohort. JAIND. Pub ahead of print (January 2017). doi: 10.1097/QAI.0000000000001249.

Gender and racial differences

Hatleberg CI et al. Gender differences in HIV-positive persons in use of cardiovascular disease-related interventions: D:A:D study. HIV Drug Therapy Glasgow Congress, 2-6 November 2014. Oral abstract O324. Journal of the International AIDS Society 2014, 17(Suppl 3):19516
Webcast: Wednesday 5 November, Co-morbidities and Complications Part II.

Kempf M-C et al. Gender Differences in Discontinuation of Antiretroviral Treatment Regimens. JAIDS: November 2009 – Volume 52 – Issue 3 – pp 336-341, doi: 10.1097/QAI.0b013e3181b628be.

Tedaldi E et al. Ethnicity race and gender: differences in serious adverse events among participants in an antiretroviral initiation trial: results of CPCRA 058 (FIRST Study). JAIDS: 1 April 2008 – Volume 47 – Issue 4 – pp 441-448, doi: 10.1097/QAI.0b013e3181609da8.,_Race,_and_Gender__Differences_in.5.aspx

Barber T et al. Outcomes of first line highly active antiretroviral therapy (HAART) among men and women in the UK CHIC study. 12th European AIDS Conference (EACS), 11-14 November 2009, Cologne. Abstract PE10.4/1.

Koegl C et al. No subjective or objective gender differences in ART-naïve patients initiating a lopinavir/ritonavir-based regimen. 48 week data from the German STAR and STELLA cohorts. 12th European AIDS Conference (EACS), 11-14 November 2009, Cologne. Abstract PE 7.9/19.

Johnson M et al. Gender based differences in antiretroviral-naïve patients treated with ritonavir-boosted protease inhibitors: results from the CASTLE study through 96 weeks. 12th European AIDS Conference (EACS), 11-14 November 2009, Cologne. Abstract PE7.3/8.

Squires K et al. Rates and predictors of adherence in treatment experienced women and men in GRACE (Gender, Race And Clinical Experience). 12th European AIDS Conference (EACS), 11-14 November 2009, Cologne. Abstract PE10.1/2.

TDM and drug levels

Lab 21: Therapeutic Drug Monitoring

Back D, Khoo S. The role of therapeutic drug monitoring in the management of HIV infection. (2008) (PDF)

Boffito M et al. Therapeutic drug monitoring and drug-drug interactions involving antiretroviral drugs. Special article – Part 2. Antiviral Therapy10:469-477.

Best BM et al. A randomized controlled trial of therapeutic drug monitoring in treatment-naive and -experienced HIV-1-infected patients. JAIDS: 1 December 2007 – Volume 46 – Issue 4 – pp 433-442. doi: 10.1097/QAI.0b013e318156f029.

Fabbiani M et al. Pharmacokinetic variability of antiretroviral drugs and correlation with virological outcome: 2 years of experience in routine clinical practice. J Antimicrob Chemother. 2009 Jul;64(1):109-17. Epub 2009 Apr 27.

La Porte CJM et al. Updated guideline to perform therapeutic drug monitoring for antiretroviral agents. Rev Antiviral Ther 2006; 3: 3-14.

Ray JE et al. Therapeutic drug monitoring of atazanavir: surveillance of pharmacotherapy in the clinic. British Journal of Clinical Pharmacology. Volume 60, Issue 3, pages 291-299, September 2005. DOI: 10.1111/j.1365-2125.2005.02413.x.

Ståhle L et al. Efavirenz plasma concentrations in HIV-infected patients: inter- and intraindividual variability and clinical effects. Therapeutic Drug Monitoring: June 2004 – Volume 26 – Issue 3 – pp 267-270.

Saitoh A et al. Efavirenz pharmacokinetics in HIV-1-infected children are associated with CYP2B6-G516T polymorphism. JAIDS: 2007 Jul 1;45(3):280-5.

Generic drugs

Lepik KJ et al. Adverse drug reactions attributed to generic substitution of antiretroviral medications among HIV treatment and pre-exposure prophylaxis clients in British Columbia, Canada. Antiviral Therapy. 2024;29(1). doi:10.1177/13596535241233128

Genetics, drug levels and side effects

Cianfriglia M et al. HIV-1 integrase inhibitors are substrates for the multidrug transporter MDR1-P-glycoprotein. Retrovirology 2007, 4:17doi:10.1186/1742-4690-4-17.

Evans WE et al. Drug disposition, drug targets, and side effects. N Engl J Med 2003; 348:538-549. February 6, 2003.

Novoa SR et al. G516T polymorphism at the CYP2B6 isoenzyme significantly influences efavirenz plasma levels and the risk of neurological symptoms. 12th CROI, 22–25 February 2005, Boston. Poster abstract 652.

Vitezica ZG et al. HLA-DRB1*01 associated with cutaneous hypersensitivity induced by nevirapine and efavirenz. AIDS: 19 February 2008 – Volume 22 – Issue 4 – p 540-541. doi: 10.1097/QAD.0b013e3282f37812. Research Letter.

Switching treatment for side effects

Switch nevirapine to efavirenz after rash: “People with nevirapine rash have a 10% risk of rash if they switch to efavirenz.”

Manosuthi W et al. Incidence and risk factors of rash associated with efavirenz in HIV-infected patients with preceding nevirapine-associated rash. HIV Medicine. Volume 7, Issue 6, pages 378-382, September 2006.

Efavirenz to nevirapine

Ward DJ et al. Switch from efavirenz to nevirapine associated with resolution of efavirenz-related neuropsychiatric adverse events and improvement in lipid profiles. AIDS Patient Care and STDs Volume: 20 Issue 8: August 7, 2006.

Winston A et al. Dose escalation or immediate full dose when switching from efavirenz to nevirapine-based highly active antiretroviral therapy in HIV-1-infected individuals? AIDS: 20 February 2004 – Volume 18 – Issue 3 – pp 572-574. Research letter.

Mehta U et al. Is it safe to switch between efavirenz and nevirapine in the event of toxicity? The Lancet Infectious Diseases, Volume 7, Issue 11, Pages 733 – 738, November 2007. doi:10.1016/S1473-3099(07)70262-1.

PI to nevirapine

Cooper CL. Evaluation of nevirapine-switch strategies for HIV treatment. HIV Medicine, Volume 7, Issue 8, pages 537-543, November 2006. DOI: 10.1111/j.1468-1293.2006.00418.x.

3TC to FTC

Rosario Palacios R et al. Minor emtricitabine intolerance in treatment-stable patients switched from tenofovir/lamivudine to a fixed-dose combination of tenofovir/emtricitabine (Truvada). Journal of Antimicrobial Chemotherapy. doi:10.1093/jac/dkm489.

Pollock K et al. Emtricitabine intolerance in treatment-experienced patients switched from lamivudine: a method of assessing toxicity. J Antimicrob Chemother (2006) 58:227-8.

Villar del Sax S et al. Tolerability of emtricitabine (FTC) in HIV infected subjects who switch from lamivudine (3TC) to FTC. IAS 2007, Sydney, Poster MOPEB012.

Weight changes

Bourgi, Kassem et al. Weight gain among treatment-naive persons with HIV receiving ddolutegravir in Kenya. JAIDS Journal of Acquired Immune Deficiency Syndromes: September 20, 2022 – Volume – Issue – 10.1097/QAI.0000000000003087 doi: 10.1097/QAI.0000000000003087

Lake JE et al. Risk factors for weight gain following switch to integrase inhibitor–based antiretroviral therapy. Clinical Infectious Diseases 71(9);e471–e477. (1 November 2020.

Norwood J et al. Weight gain in persons with HIV switched from efavirenz-based to integrase strand transfer inhibitor-based regimens. J Acquir Immune Defic Syndr. 201776:527–531.

Orkin C et al. Fixed-dose combination bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir-containing regimens for initial treatment of HIV-1 infection: week 144 results from two randomised, double-blind, multicentre, phase 3, non-inferiority trials. Lancet HIV. 2020 Jun;7(6):e389-e400. doi: 10.1016/S2352-3018(20)30099-0.

Palella FJ et al. Weight gain and metabolic effects in persons with HIV who switch to ART regimens containing integrase inhibitors or tenofovir alafenamide. JAIDS. doi: 10.1097/QAI.0000000000003101. (23 September 2022).

Ruderman SA et al. Weight Gain Following ART Initiation in ART-Naïve People Living With HIV in the Current Treatment Era. JAIDS: March 1 2021: 86(3)339-343. doi: 10.1097/QAI.0000000000002556

Sax PE et al. Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials. Clin Infect Dis. 2020 Sep 1271(6):1379-1389. doi: 10.1093/cid/ciz999.

Venter WDF et al for the ADVANCE study. Dolutegravir plus two different prodrugs of tenofovir to treat HIV. N Engl J Med. 2019;381:803–815.

Zino L et al. Outcomes of bariatric surgery in people with HIV: a retrospective analysis from ATHENA cohort, Clinical Infectious Diseases, 2023; ciad404.

John PH et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021 384:989-1002. DOI: 10.1056/NEJMoa2032183. (18 March 2021).

Diarrhoea and wasting

Carroccio A et al. Efficacy of oral pancreatic enzyme therapy for the treatment of fat malabsorption in HIV-infected patients. Alimentary Pharmacology & Therapeutics, Volume 15, Issue 10, pages 1619–1625, October 2001.

Gold J et al. Effects of nandrolone decanoate compared with placebo or testosterone on HIV-associated wasting. Volume 7, Issue 3, pages 146–155, April 2006.

Guinane S et al. The effectiveness of probiotics for managing diarrhoea in people with HIV infection: a critically appraised topic. HIV Medicine Volume 14, Issue 3, pages 187–190, March 2013. DOI: 10.1111/j.1468-1293.2012.01042.x. 

Guerrant RL et al. IDSA Practice Guidelines for the Management of Infectious Diarrhea. Clinical Infectious Diseases 2001;32:331–351. 1058-4838/2001/3203-0001$03.00, DOI: 10.1086/318514.

Martin TCS et al. Pancreatic insufficiency in patients with HIV infection: role of didanosine questioned. HIV Medicine. Volume 14, Issue 3, pages 161–166, March 2013. DOI: 10.1111/j.1468-1293.2012.01047.x. 

Price DA et al. Pancreatic exocrine insufficiency in HIV-positive patients. HIV Medicine, Volume 6, Issue 1, pages 33–36, January 2005 DOI: 10.1111/j.1468-1293.2005.00263.x.

Sharma R et al. Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhoea. The Lancet Oncology, Volume 6, Issue 2, Pages 93 – 102, February 2005, doi:10.1016/S1470-2045(05)01735-3.

Spacek LA et al. Hopkins HIV Guide: Diarrhoea.

ThomasPD et al. Enteric viral infections as a cause of diarrhoea in the acquired immunodeficiency syndrome. HIV Medicine, Volume 1, Issue 1, pages 19–24, October 1999.

Nausea and vomiting

See General.

Fatigue (feeling tired)

Jong E et al. Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era. AIDS: 19 June 2010 – Volume 24 – Issue 10 – p 1387-1405. doi: 10.1097/QAD.0b013e328339d004.

Smith BA et al. Aerobic exercise: effects on parameters related to fatigue, dyspnea, weight and body composition in HIV-infected adults. AIDS: 13 April 2001 – Volume 15 – Issue 6 – pp 693-701.

Skin problems: rash, dry skin (mainly HIV, low CD4, OI and IDV)

Nevirapine rash

Antinori A et al. Female sex and the use of anti-allergic agents increase the risk of developing cutaneous rash associated with nevirapine therapy. AIDS: 17 August 2001 – Volume 15 – Issue 12 – pp 1579-1581. Research letter.

Kiertiburanakul S et al. Risk factors for nevirapine-associated rash among HIV-infected patients with low CD4 cell counts in resource-limited settings. Current HIV Research, Volume 6, Number 1, January 2008 , pp. 65-69(5).

Montaner J et al. Randomized controlled study of the effects of a short course of prednisone on the incidence of rash associated with nevirapine in patients infected with HIV-1. JAIDS: 1 May 2003 – Volume 33 – Issue 1 – pp 41-46.,_Controlled_Study_of_the_Effects_of_a.7.aspx

Ananworanich J et al. Incidence and risk factors for rash in Thai patients randomized to regimens with nevirapine, efavirenz or both drugs. AIDS: 28 January 2005 – Volume 19 – Issue 2 – p 185-192.

Soriano V et al. Is there cross-toxicity between nevirapine and efavirenz in subjects developing rash? AIDS: 28 July 2000 – Volume 14 – Issue 11 – pp 1672-1673. Correspondence.

Cotrimoxazole (Septrin) rash
Diphoorn J et al. Incidence, causative factors and mortality rates of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in northern Italy: data from the REACT registry. Pharmacoepidemiol Drug Saf. 2016 Feb;25(2):196-203. doi: 10.1002/pds.3937. Epub 2015 Dec 21.

Hiransuthikul A et al. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS): 11 years retrospective study in Thailand. Allergol Int. 2016 Oct;65(4):432-438. doi: 10.1016/j.alit.2016.04.001. Epub 2016 Apr 28.

Paitorn L. Co-Trimoxazole-Induced DRESS Syndrome: A Case Report. J Med Assoc Thai. 2016 Feb;99 Suppl 2:S227-30.

Dry skin

Lee D et al. Prevalence and factors associated with dry skin in HIV infection: the FRAM study. AIDS 1 October 2007 – Volume 21 – Issue 15 – p 2051-2057, doi: 10.1097/QAD.0b013e3282eea51a.

Mental health

Wright E, Grund B, Robertson K, et al. No difference between the effects of immediate versus deferred ART on neuropsychological test performance in HIV-positive adults with CD4+ cell counts above 500 cells/µl: the Strategic Timing of Anti Retroviral Treatment (START) Neurology Substudy. 15th European AIDS Conference, October 21-24, 2015, Barcelona. Abstract PS10/6.

Grauer OM et al. Neurocognitive decline in HIV patients is associated with ongoing T-cell activation in the cerebrospinal fluid. Annals of Clinical and Translational Neurology. 2015 (18 August). Vol 2. 906–919. DOI: 10.1002/acn3.227.

Moulignier A et al. Does HIV Infection Alter Parkinson Disease? JAIDS (2015): 70(2);129–136. doi: 10.1097/QAI.0000000000000677. (1 October 2015)

Basu S et al. Clinical management of depression and anxiety in HIV-infected adults. AIDS: 2 December 2005 – Volume 19 – Issue 18 – p 2057-2067. Editorial Review.

Lampe F et al. Depression and virological status among UK HIV outpatients: results from a multicentre study. 18th BHIVA Conference, 18-20 April 2012, Birmingham. Oral abstract O10. For slides see the ASTRA study website:

National Institute for Health and Clinical Excellence. Depression in Adults (update). Depression: the treatment and management of depression in adults. National Clinical Practice Guideline 90. 2009.

National Institute for Health and Clinical Excellence. Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. National Clinical Practice Guideline Number 22. 2004.

Blumenthal JA et al. Effects of Exercise Training on Older Patients With Major Depression Arch Intern Med. 1999;159(19):2349-2356.

Neidig JL et al. Aerobic Exercise Training for Depressive Symptom Management in Adults Living With HIV Infection. Journal of the Association of Nurses in AIDS Care – March 2003 (Vol. 14, Issue 2, Pages 30-40, DOI: 10.1177/1055329002250992).

Lima VD et al. The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS: 31 May 2007 – Volume 21 – Issue 9 – p 1175-1183 doi: 10.1097/QAD.0b013e32811ebf57.

Mental health

Olmastroni E et al., Statin use and risk of dementia or Alzheimer’s disease: a systematic review and meta-analysis of observational studies, European Journal of Preventive Cardiology, Volume 29, Issue 5, March 2022, Pages 804–814,

Sexual health

Zakumumpa H et al. Patient experiences of sexual dysfunction after transition to dolutegravir-based HIV treatment in mid-Western Uganda: a qualitative study. BMC Infect Dis. 2022 Aug 15;22(1):692. doi: 10.1186/s12879-022-07673-z.

El-Shaer W et al. Intra-cavernous injection of BOTOX® (50 and 100 Units) for treatment of vasculogenic erectile dysfunction: Randomized controlled trial. Andrology. 2021 Jul;9(4):1166-1175. doi: 10.1111/andr.13010.

Monte GL et al. Women taking a “blue pill” (sildenafil citrate): such a big deal? Drug Des Devel Ther. 2014; 8: 2251–2254.

Eroxen gel (commercial website)

Toorabally NC et al. Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys. AIDS Care: 1-10;2019.

Tariq S et al. The impact of the menopause transition on the health and wellbeing of women living with HIV: a narrative review. Maturitas 88: 76-83;2016.

Dijkstra, M et al. HIV-1 status is independently associated with decreased erectile function among middle-aged MSM in the era of combination antiretroviral therapy.  AIDS (2018) 32 (9) 1137-1146. (doi: 10.1097/QAD.0000000000001800.01 June 2018).

NICE review. Erectile dysfunction: Alprostadil cream. Evidence summary [ESNM50]. December 2014.

Anaissie J and Hellstrom WJG. Clinical use of alprostadil topical cream in patients with erectile dysfunction: a review. Res Rep Urol. 2016; 8: 123–131. doi: 10.2147/RRU.S68560 (03 August 2016).

Scarsi K et al. Efavirenz- but not nevirapine-based antiretroviral therapy decreases exposure to the levonorgestrel released from a sub-dermal contraceptive implant. HIV Drug Therapy Glasgow Congress, 2-6 November 2014. Oral abstract 0131. Journal of the International AIDS Society 2014, 17(Suppl 3):19484.

Fakoya A et al. British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of , people living with HIV infection 2008. HIV Medicine (2008); 9: 681–720. DOI: 10.1111/j.1468-1293.2008.00634.x.

Moreno-Pérez O et al. Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors. AIDS: January 2010 – Volume 24 – Issue 2 – p 255–264, doi: 10.1097/QAD.0b013e328334444b.

Dukers NHTM et al. The impact of experiencing lipodystrophy on the sexual behaviour and well-being among HIV-infected homosexual men. AIDS: 13 April 2001 – Volume 15 – Issue 6 – pp 812-813. Research letter.

Lamba H et al. Antiretroviral therapy is associated with sexual dysfunction and with increased serum oestradiol levels in men. Int J STD AIDS. 2004 Apr;15(4):234-7.

Collazos J et al. Sexual Dysfunction in HIV-Infected Patients Treated With Highly Active Antiretroviral Therapy. JAIDS,1 November 2002 – Volume 31 – Issue 3 – pp 322-326.

Asboe D et al. Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors. AIDS Care 2007; 19: 955-965.

Ralph D, McNicholas T. UK management guidelines for erectile dysfunction. BMJ 2000; 321: 499-503.

Patient-focused drug development public meeting and scientific workshop on female sexual dysfunction. 27-28 August 2014.

NIH news release. FDA approves first treatment for sexual desire disorder. 18 August 2015.

Flibanserin (Addyi) prescriping information. (2015) (PDF)

Insomnia and sleep disturbance

Lampe F et al. Depression and virological status among UK HIV outpatients: results from a multicentre study. 18th BHIVA Conference, 18-20 April 2012, Birmingham. Oral abstract O10. For slides see the ASTRA study website:

Núñez M et al. Higher efavirenz plasma levels correlate with development of insomnia. JAIDS: 1 December 2001 – Volume 28 – Issue 4 – p 399. Letter.

Reid S et al. Insomnia in HIV Infection: A systematic review of prevalence, correlates, and management. Psychosomatic Medicine 67:260-269 (2005).

Biden C et al. Severe insomnia related to high concentrations of raltegravir. AIDS 2011; 25:725–727.

de Boer Mark GJ et al. Intolerance of dolutegravir-containing combination antiretroviral therapy regimens in real-life clinical practice. AIDS: 28 November 2016 – Volume 30 – Issue 18 – p 2831–2834 doi: 10.1097/QAD.0000000000001279.

CNS side effects: efavirenz, raltegravir, dolutegravir and others

Treisman GJ et al. Neurologic and psychiatric complications of antiretroviral agents. AIDS: 14 June 2002 – Volume 16 – Issue 9 – pp 1201-1215, Editorial Review.


Menard A et al. Neuropsychiatric adverse effects on dolutegravir: an emerging concern in Europe. AIDS 2017; 31:1201–1203.

Fettiplace A et al. Psychiatric symptoms in patients receiving dolutegravir. J Acquir Immune Defic Syndr 2017; 74:423–431.

Hoffmann C et al. Higher rates of neuropsychiatric adverse events leading to dolutegravir discontinuation in women and older patients. HIV Med 2017; 18:56–63.

Kheloufi F et al. Psychiatric disorders after starting dolutegravir: report of four cases. AIDS 2015; 29:1723–1725.

Harris M et al. Exacerbation of depression associated with starting raltegravir: a report of four cases. AIDS 2008; 22:1890–1892.

Kheloufi F et al. Neuropsychiatric events and dolutegravir in HIV patients: a worldwide issue involving a class effect. AIDS: 31 July 2017 – Volume 31 – Issue 12 – p 1775–1777. doi: 10.1097/QAD.0000000000001557.


Carey D. Efavirenz 400 mg daily remains non-inferior to 600 mg: 96 week data from the double-blind, placebo-controlled ENCORE1 study. 
 HIV Drug Therapy Glasgow Congress, 2-6 November 2014. Oral abstract 0421. Journal of the International AIDS Society 2014, 17(Suppl 3):19523

Yang S-P et al. Effectiveness of a reduced dose of efavirenz plus 2 NRTIs as maintenance antiretroviral therapy with the guidance of therapeutic drug monitoring. HIV Drug Therapy Glasgow Congress, 2-6 November 2014. Oral abstract 0422. Journal of the International AIDS Society 2014, 17(Suppl 3):19524

ENCORE1 Study Group. Efficacy of 400 mg efavirenz versus standard 600 mg dose in HIV-infected, antiretroviral-naive adults (ENCORE1): a randomised, double-blind, placebo-controlled, non-inferiority trial. The Lancet, 26 April 2014;383 (9927):1474 – 1482.

Smith C et al. Lack of association between use of efavirenz and death from suicide: the D:A:D Study. HIV Drug Therapy Glasgow Congress, 2-6 November 2014. Oral abstract O315. Journal of the International AIDS Society 2014, 17(Suppl 3):19512. (PDF)

Mollan et al. Association between efavirenz as initial therapy for HIV-1 infection and increased risk for suicidal ideation or attempted or completed suicide: an analysis of trial data. Ann Intern Med 2014.161(1):1-10. doi:10.7326/M14-0293.

Arenas-Pinto A et al. Increased risk of suicidal behaviour with use of efavirenz: results from the START trial. AIDS2016. Durban, South Africa. 18-22 July 2016. Oral abstract THAB0202. (Abstract) (Webcast)

Efavirenz product information. Bristol-Myers Squibb.

Poulsen HD et al. Efavirenz-induced psychosis leading to involuntary detention. AIDS: 14 February 2003 – Volume 17 – Issue 3 – pp 451-453. Correspondence.

de la Garza CLS et al. Efavirenz-induced psychosis. AIDS: 28 September 2001 – Volume 15 – Issue 14 – pp 1911-1912. Correspondence.

Sabato S et al. Efavirenz-induced catatonia. AIDS: 6 September 2002 – Volume 16 – Issue 13 – pp 1841-1842. Correspondence.

Scourfield A et al. Discontinuation of Atripla as first-line therapy in HIV-1 infected individuals. Concise communication. AIDS, 17 July 2012 – Volume 26 – Issue 11 – p 1399–1401. doi: 10.1097/QAD.0b013e328353b047.

Blanch J et al. Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz. JAIDS: 1 August 2001 – Volume 27 – Issue 4 – pp 336-343.

Boly L et al. Depressive symptoms predict increased incidence of neuropsychiatric side effects in patients treated with efavirenz. JAIDS: 1 August 2006 – Volume 42 – Issue 4 – pp 514-515, doi: 10.1097/01.qai.0000221691.61972.34. Letter to the Editor.

FTC (see other switching studies)

Pollock K, Stebbing J, Bower M, et al. Emtricitabine intolerance in treatment-experienced patients switched from lamivudine: a method of assessing toxicity. J Antimicrob Chemother (2006) 58:227-8.


Wise JEM et al. Neuropsychiatric complications of nevirapine treatment. BMJ 2002; 324:879. (13 April 2002).

Peripheral neuropathy

Smith TJ et al. A Pilot Randomized Sham-Controlled Trial of MC5-A Scrambler Therapy in the Treatment of Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN). Journal of Palliative Care, Volume 35 Issue 1. DOI: 10.1177/0825859719827. (3 February 2019).

Chatterjee P et al. Effect of deep tissue laser therapy treatment on peripheral neuropathic pain in older adults with type 2 diabetes: a pilot randomized clinical trial. BMC Geriatr 19, 218 (2019).

Cg SK et al. Efficacy of low level laser therapy on painful diabetic peripheral neuropathy. Laser Ther. 2015 Oct 2;24(3):195-200. doi: 10.5978/islsm.15-OR-12.

Chatterjee P et al. Effect of deep tissue laser therapy treatment on peripheral neuropathic pain in older adults with type 2 diabetes: a pilot randomized clinical trial. BMC Geriatr. 2019 Aug 12;19(1):218. doi: 10.1186/s12877-019-1237-5.

Abrams DI et al. Cannabis in painful HIV-associated sensory neuropathy, A randomized placebo-controlled trial. Neurolgy 2007; 68:515-521.

Backonja M et al. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther. 2003 Jan;25(1):81-104.

Breen RA et al. Increased incidence of peripheral neuropathy with co-administration of stavudine and isoniazid in HIV-infected individuals. AIDS: 31 March 2000 – Volume 14 – Issue 5 – p 615, Correspondence.

Childs EA et al. Plasma viral load and CD4 lymphocytes predict HIV-associated dementia and sensory neuropathy. Neurology 1999, Feb;52(3):607-13.

Cherry CL et al. Antiretroviral use and other risks for HIV-associated neuropathies in an international cohort. Neurology 2006, Mar 28;66(6):867-73.

Cepeda JA et al. Excess peripheral neuropathy in patients treated with hydroxyurea plus didanosine and stavudine for HIV infection. AIDS:, 18 February 2000 – Volume 14 – Issue 3 – pp 332-333, Correspondence.

Clifford DB et al. A randomized, double-blind, controlled study of NGX-4010, a capsaicin 8% dermal patch, for the treatment of painful HIV-associated distal sensory polyneuropathy. JAIDS. Volume 59 – Issue 2 – p 126–133, (1 February 2012).,_Double_Blind,_Controlled_Study_of.5.aspx

Dorfman D et al. Treatment of painful distal sensory polyneuropathy in HIV-infected patients with a topical agent: results of an open-label trial of 5% lidocaine gel. AIDS: 20 August 1999 – Volume 13 – Issue 12 – p 1589. Correspondence.

Ellis RJ et al. HIV protease inhibitors and risk of peripheral neuropathy. Ann Neurol. 2008 November; 64(5): 566–572., doi: 10.1002/ana.21484.

EMA approval documents and SPC for Qutenza capsaicin patch. (May 2009). medicines/medicines.jsp&jsenabled=true

FDA Meeting of the Anesthetic and Analgesic Drug Products Advisory Committee. (9 February 2012)

FDA. FDA approves new drug treatment for long-term pain relief after shingles attacks. (17 November 2009).

FDA briefing document for Qutenza capsaicin patch (186 pages – PDF download)

Frank B et al. Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study, BMJ 2008; 336:199. doi: 10.1136/bmj.39429.619653.80. (Published 8 January 2008),

Gerbi A et al. Fish Oil Supplementation Prevents Diabetes-Induced Nerve Conduction Velocity and Neuroanatomical Changes in Rats. The Journal of Nutrition Vol. 129 No. 1 January 1999, pp. 207-213.

Hahn K et al. A placebo-controlled trial of gabapentin for painful HIV-associated sensory neuropathies. J Neurol. 2004 Oct;251(10):1260-6.

Hart AM et al. Acetyl-l-carnitine: a pathogenesis based treatment for HIV-associated antiretroviral toxic neuropathy. AIDS: 23 July 2004 – Volume 18 – Issue 11 – pp 1549-1560.

Keswani SC et al. HIV-associated sensory neuropathies. AIDS: 8 November 2002 – Volume 16 – Issue 16 – pp 2105-2117 Editorial Review.

Mason L et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ 2004; 328: 991 doi: 10.1136/bmj.38042.506748.EE (Published 19 March 2004).

Moyle G et al. Efficacy of NGX-4010 (Qutenza), an 8% capsaicin patch, in patients with HIV-associated distal sensory polyneuropathy: results of integrated analyses. 17th International AIDS Conference, 18–23 July 2010, Vienna. Poster abstract WEPE0070.

Phillips TJC et al. Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials. PLoS One (28 December 2010). doi:10.1371/journal.pone.0014433

Semitala FC et al. Does toxicity to fixed dose stavudine, lamivudine and nevirapine regimen affect virologic suppression among HIV infected adults at the Infectious Diseases Institute, Makerere University? JAIDS: June 2009 – Volume 51 – Supplement 2, 11th Anniversary Annual International Meeting of the Institute of Human Virology. Abstract 257. doi: 10.1097/01.qai.0000351212.54681.a4.,.162.aspx

Shlay JC et al. Acupuncture and amitriptyline for pain due to HIV-related peripheral neuropathy, a randomized controlled trial. JAMA. 1998;280:1590-1595.

Simpson DM et al. Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy. Neurology 2008;70:2305-2313.

Youle M et al. A double-blind, parallel-group, placebo-controlled, multicentre study of acetyl l-carnitine in the symptomatic treatment of antiretroviral toxic neuropathy in patients with HIV-1 infection. HIV Medicine, Volume 8, Issue 4, pages 241–250, May 2007.

Weintraub MI et al. Static magnetic field therapy for symptomatic diabetic neuropathy: a randomized double-blind placebo-controlled trial. Arch Phys Med Rehabil Vol 84, May 2003.

Winemiller MH et al. Effect of magnetic vs sham-magnetic insoles on plantar heel pain, a randomized controlled trial. JAMA. 2003;290:1474-1478.

Liver toxicity, rash and nevirapine

Huntington S et al. Does pregnancy increase the risk of ART-induced hepatotoxicity among HIV-positive women? HIV Drug Therapy Glasgow Congress, 2-6 November 2014. Oral abstract O133. Journal of the International AIDS Society 2014, 17(Suppl 3):19486

Kovari H et al. Antiretroviral drug-related liver mortality among HIV-positive persons in the absence of HBV or HCV co-infection. The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study. Clin Infect Dis (22 October 2012 Advance access)

“Rash associated with liver toxicity is likely to be immune mediated hypersensitivty reaction with a genetic HLA associated, rash without liver toxicty is a different mechanism unlinked to CD4 count”

Martínez E et al. Hepatotoxicity in HIV-1-infected patients receiving nevirapine-containing antiretroviral therapy. AIDS: 6 July 2001 – Volume 15 – Issue 10 – pp 1261-1268.

Stern JO et al. A comprehensive hepatic safety analysis of nevirapine in different populations of HIV infected patients. JAIDS: 2003;34(suppl 1):S21-33.

Baylor MS et al. Hepatotoxicity Associated With Nevirapine Use. JAIDS: 15 April 2004 – Volume 35 – Issue 5 – pp 538-539. Letters to the Editor.

Martin AM et al. Predisposition to nevirapine hypersensitivity associated with HLA-DRB1*0101 and abrogated by low CD4 T-cell counts. AIDS: 3 January 2005 – Volume 19 – Issue 1 – p 97-99. Research Letter.


Noureddin M et al. Embracing Change: From Nonalcoholic Fatty Liver Disease to Metabolic Dysfunction-Associated Steatotic Liver Disease Under the Steatotic Liver Disease Umbrella. Clin Gastroenterol Hepatol. 2023 Oct 15:S1542-3565(23)00833-9. doi: 10.1016/j.cgh.2023.09.034.

Loomna R et al. Semaglutide 2·4 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trial. Lancer (16 March 2023)..

Diagnosis and Management of Nonalcoholic Fatty Liver Disease. Leung PB et al. JAMA. doi:10.1001/jama.2023.17935. (16 October 2023).

Updated practice guidance fatty liver: State of the art new practice guidelines for NAFLD . Updates to 2018 guidelines. (Nov 2022).

Diagnosis and management of nonalcoholic fatty liver disease patient guideline
American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Setting [2018, updated May 2022]

Riebensahm C et al. Decreased physical activity and prolonged sitting time are associated with liver steatosis in people with HIV. JAIDS Journal of AIDS), 23 November 2023. DOI: 10.1097/QAI.0000000000003328.

Lactic acidosis

Arenas-Pinto A et al. Lactic acidosis in HIV infected patients: a systematic review of published cases. Sex Transm Infect 2003;79:340-343 doi:10.1136/sti.79.4.340.

Moyle G et al. Hyperlactataemia and lactic acidosis during antiretroviral therapy: relevance, reproducibility and possible risk factors. AIDS, 5 July 2002 – Volume 16 – Issue 10 – pp 1341-1349.

Geddes R et al. A high incidence of nucleoside reverse transcriptase inhibitor (NRTI)-induced lactic acidosis in HIV-infected patients in a South African context. Southern African Medical Journal. August 2006, Vol. 96, No. 8.

Butt AA. Fatal lactic acidosis and pancreatitis associated with ribavirin and didanosine therapy, AIDS Read. 2003;13(7).

Mandelbrot TL et al. Case report: nucleoside analogue-induced lactic acidosis in the third trimester of pregnancy. AIDS, 24 January 2003 – Volume 17 – Issue 2 – pp 272-273.

Murphy MD et al. Fatal lactic acidosis and acute renal failure after addition of tenofovir to an antiretroviral regimen containing didanosine. Clin Infect Dis. 2003;36:1082-1085.

Osler M et al. Risk factors for and clinical characteristics of severe hyperlactataemia in patients receiving antiretroviral therapy: a case–control study. HIV Medicine, Volume 11, Issue 2, pages 121–129, February 2010.

Wester CW et al. Higher-than-expected rates of lactic acidosis among HAART-treated women in Botswana: preliminary results from a large randomized clinical trial. JAIDS: 1 November 2007 – Volume 46 – Issue 3 – pp 318-322, doi: 10.1097/QAI.0b013e3181568e3f.

Hepatic steatosis, pancreatitis and pancreatic insufficiency

Rate in HIV and d4T/ddI/hydroxyurea

Reisler RB et al. Incidence of Pancreatitis in HIV-1–Infected Individuals Enrolled in 20 Adult AIDS Clinical Trials Group Studies. JAIDS: 2005 June 1; 39(2): 159–166.

Low rates with cumulative expose to RTIs

Smith CJ et al. The role of antiretroviral therapy in the incidence of pancreatitis in HIV-positive individuals in the EuroSIDA study. AIDS: 2 January 2008 – Volume 22 – Issue 1 – p 47-56, doi: 10.1097/QAD.0b013e3282f03094.

No increased risk from HCV coinfection, perhaps because low BMI?

Monto A et al. Hepatic steatosis in HIV/hepatitis C coinfection: prevalence and significance compared with hepatitis C monoinfection. Hepatology, Vol. 42, No. 2, 2005.

No increased risk from statins

Thisted H et al. Statins and the risk of acute pancreatitis: a population-based case-control study. Aliment Pharmacol Ther. 2006 Jan 1;23(1):185-90.

Singh S, Loke YK. Statins and pancreatitis: a systematic review of observational studies and spontaneous case reports. Drug Saf. 2006;29(12):1123-32.


Pancreatology. 2004;4(1):42-8. Epub 2004 Feb 24., Is obesity a risk factor in acute pancreatitis? A meta-analysis., Martínez J

Alcohol induced in SA

Anderson F et al. Acute pancreatitis: demographics, aetiological factors and outcomes in a regional hospital in South Africa. S Afr J Surg. 2008 Aug;46(3):83-6.

Pancreatic insufficiency

Yilmaz A, Hagberg L. Exocrine pancreatic insufficiency is common in people living with HIV on effective antiretroviral therapy. Infect Dis (Lond). 2018 Mar;50(3):193-199. doi: 10.1080/23744235.2017.1370126. Epub 2017 Aug 25.

Martin TC et al. Pancreatic insufficiency in patients with HIV infection: role of didanosine questioned. HIV Med. 2013 Mar;14(3):161-6. doi: 10.1111/j.1468-1293.2012.01047.x. Epub 2012 Sep 21.

Price DA et al. Pancreatic exocrine insufficiency in HIV-positive patients. HIV Med. 2005 Jan;6(1):33-6. doi: 10.1111/j.1468-1293.2005.00263.x.

Khan A et al. Staging exocrine pancreatic dysfunction. Pancreatology. 2022 Jan;22(1):168-172. doi: 10.1016/j.pan.2021.11.005. Epub 2021 Nov 19. PMID: 34916141.

HIV and fatty liver disease

Updated Practice Guidance Fatty Liver: State of The Art New Practice Guidelines for NAFLD . Updates to 2018 guidelines. (Nov 2022).

Diagnosis and Management of Nonalcoholic Fatty Liver Disease Patient Guideline
American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Setting [2018, updated May 2022]

British Liver Trust. Non-alcoholic fatty liver disease (NAFLD).

Crum-Cianflone M et al. Nonalcoholic Fatty Liver Disease (NAFLD) among HIV-Infected Persons. J Acquir Immune Defic Syndr. 2009 Apr 15; 50(5): 464–473. doi: 10.1097/QAI.0b013e318198a88a.

Garvey L et al. NAFLD (Non alcohol fatty acid liver disease): an emerging problem. 22nd Annual BHIVA Conference, 19-22 April 2016, Manchester. Plenary lecture. (PDF slides) (webcast)

Guaraldi G et al. Nonalcoholic fatty liver disease in HIV-infected patients referred to a metabolic clinic: prevalence, characteristics, and predictors. Clin Infect Dis. 2008;47:250-257.

Harrison SA et al. Orlistat for overweight subjects with nonalcoholic steatohepatitis: A randomized, prospective trial. Hepatology 2009;49:80-86,

Johnson SA et al. Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss.. Hepatology 2009;50:1105-1112.

Lake J et al. Hepatic steatosis is common in both younger and older adults living with HIV and associated with divergent immuno-metabolic profiles. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 7.  Reported in HTB October 2018.

Mathurin P et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease.Gastroenterology 2009;137:532-40.

Maurice JB et al. Prevalence and risk factors of nonalcoholic fatty liver disease in HIV-monoinfection. AIDS 31: 1621-32, 2017.

Morse CG. Fatty liver disease in HIV: common, underappreciated, and understudied. AIDS 31: 1633-35, 2017.,.15.aspx

Neuschwander-Tetri BA et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015. 385 (9972): 956-965.

NHS. Non-alcoholic fatty liver disease (NAFLD).

Promrat K et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology 2010;51:121-129.

Safadi R et al. The fatty acid-bile acid conjugate Aramchol reduces liver fat content in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2014 Dec;12(12):2085-91.

Shojaee-Moradie F et al. Exercise training reduces fatty acid availability and improves the insulin sensitivity of glucose metabolism. Diabetologica 2007;50:404-413.

Vodkin I et al. Clinical, biochemical and histological differences between HIV-associated NAFLD and primary NAFLD: a case – control study. Aliment Pharmacol Ther 2015;41:368–78. (PDF)

Yang F et al, Temporal Trend and Clinical Outcomes in HIV and Non-HIV Patients following Liposuction: A Propensity-Matched Analysis. Plastic and Reconstructive Surgery 151(1):p 47e-55e, January 2023. | DOI: 10.1097/PRS.0000000000009795.

Abacavir hypersensitivity

Abacavir product information. ViiV/GSK.

Mallal S et al. HLA-B*5701 Screening for Hypersensitivity to Abacavir, NEJM Volume 358:568-579 February 7, 2008 Number 6.

Young B et al. First large, multicenter, open-label study utilizing HLA-B*5701 screening for abacavir hypersensitivity in North America. AIDS:, 20 August 2008 – Volume 22 – Issue 13 – p 1673-1675, doi: 10.1097/QAD.0b013e32830719aa.,_multicenter,_open_label_study.19.aspx

Mallal S et al. Association between presence of HLA-B*5701, HLA-DR7, and HLA-DQ3 and hypersensitivity to HIV-1 reverse-transcriptase inhibitor abacavir. The Lancet, Volume 359, Issue 9308, Pages 727-732.

Tenofovir HSR

Lockhart SM et al. Cutaneous reactions with tenofovir disoproxil fumarate: a report of nine cases. AIDS. 2007 21(10):1370-1373, (June 2007).

de Perio MA et al. A Truvada hypersensitivity reaction simulating abacavir hypersensitivity. AIDS: October 2007 – Volume 21 – Issue 16 – p 2252-2253 doi: 10.1097/QAD.0b013e3282f08b84.

Kidney side effects, kidney stones, gall stones

Yombi JC et al. Monitoring of kidney function in HIV-positive patients. HIV Medicine Sept 2015 16(8) 457-477. DOI: 10.1111/hiv.12249

Poinsignon Y et al. Complicated atazanavir-associated cholelithiasis: a report of eight documented cases among 11 cases. 19th International AIDS Conference. 22-27 July 2012, Washington. Poster abstract MOPE099.

Rakotondravelo S et al. Complicated atazanavir-associated cholelithiasis: a report of 14 cases. Clin Infect Dis. (2012) 55 (9): 1270-1272. doi: 10.1093/cid/cis620. First published online: 19 July 2012.

Hamada Y et a. High incidence of renal stones among HIV-infected patients on ritonavir-boosted atazanavir than in those receiving other protease inhibitor–containing antiretroviral Therapy. Clin Infect Dis. (2012) 55 (9): 1270-1272. doi: 10.1093/cid/cis621. First published online: 19 July 2012. 

Mocroft A et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients, AIDS:, 17 July 2010 – Volume 24 – Issue 11 – p 1667–1678, doi: 10.1097/QAD.0b013e328339fe53,

Gupta SK et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America., Clin Infect Dis. 2005; 40(11):1559-85.

Izzedine H et al. The nephrologist in the HAART era, AIDS:, 19 February 2007 – Volume 21 – Issue 4 – p 409-421, doi: 10.1097/QAD.0b013e328011ec40,

Kidney safety associated with tenofovir

Nishijima T et al. Long-term exposure to tenofovir continuously decreases renal function in HIV-1-infected patients with low body weight: results from 10 years of follow-up. AIDS. 2014; 28: 1903-1910.

Tenofovir Product Information. Summary of Product Characteristics and Patient Information Leaflet. Gilead.

Joel E. Gallant et al. Tenofovir DF, Emtricitabine, and Efavirenz vs. Zidovudine, Lamivudine, and Efavirenz for HIV. N Engl J Med 2006; 354:251-260 January 19, 2006.

Nelson MR et al. The safety of tenofovir disoproxil fumarate for the treatment of HIV infection in adults: the first 4 years. AIDS: June 2007 – Volume 21 – Issue 10 – p 1273-1281 doi: 10.1097/QAD.0b013e3280b07b33.

Karras A, Lafaurie M, Furco A, et al. Tenofovir-related nephrotoxicity in human immunodeficiency virus-infected patients: three cases of renal failure, Fanconi syndrome, and nephrogenic diabetes insipidus. Clin Infect Dis 2003;36:1070-1073

Wever K et al. Incomplete Reversibility of Tenofovir-Related Renal Toxicity in HIV-Infected Men. JAIDS: 1 September 2010 – Volume 55 – Issue 1 – pp 78-81, doi: 10.1097/QAI.0b013e3181d05579.

Leport C et al. Long‐term evolution and determinants of renal function in HIV‐infected patients who began receiving combination antiretroviral therapy in 1997–1999, ANRS CO8 APROCO‐COPILOTE. Clin Infect Dis. 2009 Dec 15;49(12):1950-4. DOI: 10.1086/648445.

Fux CA et al. Tenofovir use is associated with a reduction in calculated glomerular filtration rates in the Swiss HIV Cohort Study. Antivir Ther 2007; 12:1165–73.

Choi A et al. HIV-infected persons continue to lose kidney function despite successful antiretroviral therapy, AIDS. 23(16):2143-2149, October 23, 2009. DOI: 10.1097/QAD.0b013e3283313c91.

Bansi L et al on behalf of the UK CHIC/ESRF study group. Clinical epidemiology of HIV-associated end-stage renal failure in the UK AIDS. 23(18):2517-2521, 27 November 2009. doi: 10.1097/QAD.0b013e3283320e12.

Peyrière H et al. Renal Tubular Dysfunction Associated With Tenofovir Therapy: Report of 7 Cases, JAIDS: 1 March 2004 – Volume 35 – Issue 3 – pp 269-273.

Crixivan (indinavir sulfate). Summary of product characteristics. Merck Sharpe & Dohme; 1996.

Koop JB et al. Crystalluria and Urinary Tract Abnormalities Associated with Indinavir, Ann Int Med. July 15, 1997 vol. 127 no. 2 119-125.

Chan-Tack KM et al. Atazanavir-associated nephrolithiasis: cases from the US Food and Drug Administration’s adverse event reporting system. AIDS: Volume 21(9)31 May 2007p 1215-1218.

Izzedine H et al. Efavirenz urolithiasis. AIDS: September 2007 – Volume 21 – Issue 14 – p 1992, doi: 10.1097/QAD.0b013e3282ef792f. Correspondence.

Post F et al. Randomized comparison of renal effects, efficacy, and safety with once-daily abacavir/lamivudine versus tenofovir/emtricitabine, administered with efavirenz, in antiretroviral-naive, HIV-1-infected adults: 48-week results from the ASSERT study. J Acquir Immune Defic Syndr. 2010 Sep 1;55(1):49-57.,_Efficacy,.6.aspx

Hug et al. Treatment for human immunodeficiency virus with indinavir may cause relevant urological side-effects, effectively treatable by rehydration. BJU International. Volume 84, Issue 6, pages 610–614, October 1999.

Increased bilirubin, jaundice (yellow skin or eyes)

Atazanavir product information, Bristol-Myers Squibb

Atazanavir Plasma Levels Associated with Efficacy and Safety in Protease Inhibitor-experienced HIV-infected Patients. Program Abstr Conf Retrovir Oppor Infect 11th 2004 San Franc Calif. 2004 Feb 8-11; 11: abstract no. 606.

Rodríguez-Nóvoa S et al. Genetic factors influencing atazanavir plasma concentrations and the risk of severe hyperbilirubinemia. AIDS:, 2 January 2007 – Volume 21 – Issue 1 – p 41-46, doi: 10.1097/QAD.0b013e328011d7c1,

T-20 side effects

T-20 product information. Roche Laboratories.

Clotet B et al. Clinical management of treatment-experienced, HIV-infected patients with the fusion inhibitor enfuvirtide: consensus recommendations. AIDS: 21 May 2004 – Volume 18 – Issue 8 – pp 1137-1146.,.7.aspx

Lipodystophy and metabolic changes

Kotler D, Tebas P, Wohl D et al. HIV and Cardiometabolic Abnormalities: New Perspectives and Treatment Update. JAIDS September 1, 2008 – Volume 49 – Supplement 2.

Tien PC, Cole SR, Williams CM, et al. Incidence of lipoatrophy and lipohypertrophy in the women’s interagency HIV study. JAIDS: 2003;34:461-466.

Brown T et al. Longitudinal anthropometric changes in HIV-infected and HIV-uninfected men. JAIDS: 1 November 2006 – Volume 43 – Issue 3 – pp 356-362, doi: 10.1097/01.qai.0000243052.73321.8e.

Aldrovandi GM et al. Morphologic and metabolic abnormalities in vertically HIV-infected children and youth. AIDS: 27 March 2009 – Volume 23 – Issue 6 – p 661-672. doi: 10.1097/QAD.0b013e3283269dfb.

Lipoatrophy is predominant feature of HIV-related lipodystrophy

Bacchetti P et al. Fat distribution in men with HIV infection. Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). JAIDS: 2005 Oct 1;40(2):121-31.

Lichtenstein K et al. HIV-associated adipose redistribution syndrome (HARS): definition, epidemiology and clinical impact. AIDS Research and Therapy 2007;4:16. doi:10.1186/1742-6405-4-16.

Impact of HIV and viraemia

Kotler DP et al. Studies of Body Composition and Fat Distribution in HIV-Infected and Control Subjects. Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology: 1 March 1999 – Volume 20 – Issue 3 – pp 228-237.

Role of NRTS in lipoatrophy – skin biopsy

Nolan D et al. Mitochondrial DNA depletion and morphologic changes in adipocytes associated with nucleoside reverse transcriptase inhibitor therapy. AIDS:, 13 June 2003 – Volume 17 – Issue 9 – pp 1329-1338.

Nolan D. Differential effects of nucleoside reverse transcriptase inhibitor (NRTI) regimens on adipocyte mitochondrial DNA depletion in HIV-infected patients. 6th Lipodystrophy Workshop, Washington, 2004.

Mallal SA et al. Contribution of nucleoside analogue reverse transcriptase inhibitors to subcutaneous fat wasting in patients with HIV infection. AIDS. 2000 Jul 7;14(10):1309-16.

van der Valk M et al. Increased risk of lipodystrophy when nucleoside analogue reverse transcriptase inhibitors are included with protease inhibitors in the treatment of HIV-1 infection. AIDS. 2001 May 4;15(7):847-55.

Higher lipoatrophy with efavirenz vs lopinavir/r

Haubrich R et al.Metabolic outcomes in a randomized trial of nucleoside, nonnucleoside and protease inhibitor-sparing regimens for initial HIV treatment (ACTG 5142). AIDS: 1 June 2009 – Volume 23 – Issue 9 – p 1109-1118, doi: 10.1097/QAD.0b013e32832b4377.

NOTE – EFV+AZT+3TC vs LPV/r mono – ie could be AZT effect

Cameron DW et al. Significant Sparing of Peripheral Lipoatrophy by HIV Treatment with LPV/r + ZDV/3TC Induction followed by LPV/r Monotherapy Compared with EFV + ZDV/3TC. CROI 2007. Oral abstract 44.

Enlarged breasts in men (gynaecomastia): ART, efavirenz and other causes

Essafi MA et al. Reversible gynecomastia in HIV-infected man treated with triple antiretroviral therapy containing efavirenz: a case report. Cureus. 2022 Aug 14;14(8):e27991. doi: 10.7759/cureus.27991. PMID: 36120227; PMCID: PMC9469751.

Shawarira-Bote S et al. Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe. BMC Infectious Diseases, volume 19, Article number: 715 (2019). (13 August 2019).

Singano V et al. (2017) The burden of gynecomastia among men on antiretroviral therapy in Zomba, Malawi. PLoS ONE 12(11): e0188379.

Njuguna C et al. A case series of ART-associated gynaecomastia reported to the national HIV and TB healthcare workers (HCW) hotline. 2014 Southern African Clinicians Society Conference, 24-27 September 2014, Cape Town, South Africa. (PDF)

Sikora MJ et al Efavirenz directly modulates the oestrogen receptor and induces breast cancer cell growth. HIV Medicine October 2010, Volume 11, Issue 9 Pages 545–609.

Benveniste O et al. Successful percutaneous dihydrotestosterone treatment of gynaecomastia occurring during highly active antiretroviral therapy: four cases and a review of the literature. Clinical Infectious Diseases 2001;33:891-893.

Biglia A et al. Gynecomastia among HIV-infected patients is associated with hypogonadism: a case-control study. Clinical Infectious Diseases, 39(10):1514–1519, (15 November 2004).

Fat loss drives HIV-related lipodystrophy (both limb and trunk)

Tien PC, Grunfeld C. What is HIV-associated lipodystrophy? Defining fat distribution changes in HIV infection. Current Opinion in Infectious Diseases: February 2004 – Volume 17 – Issue 1 – pp 27-32.

Arpadi S et al. Longitudinal changes in regional fat content in HIV-infected children and adolescents. AIDS: 31 July 2009 – Volume 23 – Issue 12 – p 1501-1509, doi: 10.1097/QAD.0b013e32832b7e69.

Blanes M et al. Angiolipomas, a rare manifestation of HIV-associated lipodystrophy. AIDS. 22(4):552-554, February 19, 2008. doi: 10.1097/QAD.0b013e3282f56b7a,%20_a_rare_manifestation_of.24.aspx

Lipoatrophy management and treatment

Capeau J et al. A six month interruption in HIV-infected patients improves adipose tissue morphology and gene expression (ANRS EP29 Lipostop). 8th IWADRLH, September 2006, San Francisco. Abstract 5. Report in HTB:

Moyle GJ et al. A randomized comparative trial of tenofovir DF or abacavir as replacement for a thymidine analogue in persons with lipoatrophy. AIDS 2006; 20:2043–2050.

Fisher M et al. A randomized comparative trial of continued zidovudine/lamivudine or replacement with tenofovir disoproxil fumarate/emtricitabine in efavirenz-treated HIV-1-infected individuals. JAIDS: August 2009 – Volume 51 – Issue 5 – pp 562-568 doi: 10.1097/QAI.0b013e3181ae2eb9

Carr A et al. Abacavir substitution for nucleoside analogs in patients with HIV lipoatrophy: a randomized trial (MITOX). JAMA. 2002 Jul 10;288(2):207-15.

Martin A et al. Reversibility of lipoatrophy in HIV-infected patients 2 years after switching from a thymidine analogue to abacavir: the MITOX Extension Study. AIDS:, 30 April 2004 – Volume 18 – Issue 7 – pp 1029-1036.

Rosen S et al. Cost and cost-effectiveness of switching from stavudine to tenofovir in first-line antiretroviral regimens in South Africa. JAIDS: 1 July 2008 – Volume 48 – Issue 3 – pp 334-344, doi: 10.1097/QAI.0b013e31817ae5ef.

Valantin M-A et al. Polylactic acid implants (New-Fill)(R) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA. AIDS. 17(17):2471-2477, November 21, 2003.

Moyle G et al. A randomized open-label study of immediate versus, delayed polylactic acid injections for the cosmetic, management of facial lipoatrophy in persons with HIV infection. HIV Medicine (March 2004);5; 82–87.

Levy RM, Redbord KP, Hanke CW. Treatment of HIV lipoatrophy and lipoatrophy of aging with poly-L-lactic acid: a prospective 3-year follow-up study. J Am Acad Dermatol 2008; 59: 923–933.

Poly-L-lactic acid (New-Fill, Sculptra): FDA approval and efficacy

Silvers SL et al. Prospective, open-label, 18-month trial of calcium hydroxylapatite (Radiesse) for facial soft-tissue augmentation in patients with HIV-associated lipoatrophy: one-year durability. Plastic & Reconstructive Surgery: 1 September 2006 – Volume 118 – Issue 3S – pp 34S-45S, doi: 10.1097/01.prs.0000234847.36020.52.,_Open_Label,_18_Month_Trial_of_Calcium.8.aspx

Radiesse: FDA approval and efficacy

Carruthers A et al. Radiographic and computed tomographic studies of calcium hydroxylapatite for treatment of HIV–associated facial lipoatrophy and correction of nasolabial folds. Dermatologic Surgery, Volume 34, pages S78–S84, June 2008.

Skeie L et al. Large particle hyaluronic acid for the treatment of facial lipoatrophy in HIV-positive patients: 3-year follow-up study (Restylane SubQ). HIV Medicine 2010;11(3):170-177.

Loutfy MR et al. Immediate versus delayed polyalkylimide gel injections to correct facial lipoatrophy in HIV-positive patients. AIDS: 31 May 2007 – Volume 21 – Issue 9 – p 1147-1155, doi: 10.1097/QAD.0b013e3281c6148d.

Ross AH et al. Long-term orbito-facial complications of polyalkylimide 4% (Bio-Alcamid). Plastic & Reconstructive Surgery: September/October 2009 – Volume 25 – Issue 5 – pp 394-397, doi: 10.1097/IOP.0b013e3181b3ac71.

Karim RB et al. Complications of polyalkylimide 4% injections (Bio-Alcamid): a report of 18 cases. J Plast Reconstr Aesthet Surg. 2006;59(12):1409-14. Epub 2006 Jul 7.

Fontdevila J et al. Co(mplications with Bioalcamid in the aesthetic treatment of lipoatrophy. Abstract 100. Antiviral Therapy. 2006; 11: L60.

Goldan O et al. Early and late complications after a nonabsorbable hydrogel polymer injection: a series of 14 patients and novel management. Dermatologic Surgery, Volume 33, pages S199–S206, December 2007.

Alijotas-Reig J et al. Delayed immune-mediated adverse effects of polyalkylimide dermal fillers, clinical findings and long-term follow-up. Arch Dermatol. 2008;144(5):637-642.

Nadarajah J et al. Infectious complications of Bio-Alcamid soft tissue endoprosthesis treatment of HIV-associated facial lipoatrophy. 12th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV. Oral abstract O28. Antiviral Therapy 2010; 15 Suppl 4:A22.

Pravastatin increases limb fat in people with elevated cholesterol

Mallon PWG et al. Effect of pravastatin on body composition and markers of cardiovascular disease in HIV-infected men-a randomized, placebo-controlled study. AIDS:, 24 April 2006 – Volume 20 – Issue 7 – p 1003-1010, doi: 10.1097/01.aids.0000222072.37749.5a

Tungsiripat M et al. Rosiglitazone improves lipoatrophy in patients receiving thymidine-sparing regimens. AIDS: 1 June 2010 – Volume 24 – Issue 9 – p 1291–1298, doi: 10.1097/QAD.0b013e328339e274.

Rosiglitazone (lipoatrophy treatment)

Mafong DD et al. Development of multiple lipomas during treatment with rosiglitazone in a patient with HIV-associated lipoatrophy. AIDS: 20 August 2004 – Volume 18 – Issue 12 – pp 1742-1744.

Jones DH et al. Highly purified 1000-cSt silicone oil for treatment of HIV-associated facial lipoatrophy: an open pilot trial. Dermatologic Surgery, Volume 30, Issue 10, pages 1279–1286, October 2004.

Guaraldi g et al. Facial fat hypertrophy in patients who receive autologous fat tissue transfer. Autologous Fat Transfer 2010, Part 6, 427-431, DOI: 10.1007/978-3-642-00473-5_55.

Levan P et al. Correction of facial lipoatrophy in HIV-infected patients on highly active antiretroviral therapy by injection of autologous fatty tissue. AIDS: 27 September 2002 – Volume 16 – Issue 14 – pp 1985-1987. Correspondence.

Lipohypertrophy – (also see references for weight loss)


Yang F et al, Temporal Trend and Clinical Outcomes in HIV and Non-HIV Patients following Liposuction: A Propensity-Matched Analysis. Plastic and Reconstructive Surgery 151(1):p 47e-55e, January 2023. | DOI: 10.1097/PRS.0000000000009795.

Diet and exercise

Jones SP. Short-term exercise training improves body composition and hyperlipidaemia in HIV-positive individuals with lipodystrophy. AIDS: 19 October 2001 – Volume 15 – Issue 15 – pp 2049-2051. Research Letter.

Driscoll SD. Effects of exercise training and metformin on body composition and cardiovascular indices in HIV-infected patients. AIDS: 20 February 2004 – Volume 18 – Issue 3 – pp 465-473.

Agin D et al. Effects of whey protein and resistance exercise on body cell mass, muscle strength, and quality of life in women with HIV. AIDS: 7 December 2001 – Volume 15 – Issue 18 – pp 2431-2440.

McCarty MF. Iatrogenic lipodystrophy in HIV patients – the need for very-low-fat diets. Medical Hypotheses 61(5–6); 561-566. (November–December 2003)

Roubenoff R et al. A pilot study of exercise training to reduce trunk fat in adults with HIV-associated fat redistribution. AIDS: 30 July 1999 – Volume 13 – Issue 11 – pp 1373-1375. Concise Communication.

Fitch KV et al. Effects of a lifestyle modification program in HIV-infected patients with the metabolic syndrome. AIDS: 11 September 2006 – Volume 20 – Issue 14 – p 1843-1850. doi: 10.1097/01.aids.0000244203.95758.db.

Joy et al. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. AIDS: 31 July 2007 – Volume 21 – Issue 12 – p 1591-1600 doi: 10.1097/QAD.0b013e32823644ff.

Treatment interventions

Mulligan K et al. The effects of recombinant human leptin on visceral fat, dyslipidemia, and insulin resistance in patients with HIV-associated lipoatrophy and hypoleptinemia. Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2008-1588.


Pasquet A, Lachatre M, Soudan B, et al. Preliminary results of the study hypogonadism and persons living with HIV. ICAAC 2015, September 17-21, 2015, San Diego. Abstract H-1207.

Bhasin S et al. Effects of testosterone supplementation on whole body and regional fat mass and distribution in HIV-infected men with abdominal obesity. J Clin Endocrinol Metab 92: 1049 –1057, 2007)

Dolan Looby SE at al. Effects of long-term testosterone administration in HIV-infected women: a randomized, placebo-controlled trial. AIDS: 15 May 2009 – Volume 23 – Issue 8 – p 951-959. doi: 10.1097/QAD.0b013e3283299145.

Wanke C et al. Recombinant human growth hormone improves the fat redistribution syndrome (lipodystrophy) in patients with HIV. AIDS: 22 October 1999 – Volume 13 – Issue 15 – pp 2099-2103.

Lo JC et al. The effects of recombinant human growth hormone on body composition and glucose metabolism in HIV-infected patients with fat accumulation. Journal of Clinical Endocrinology & Metabolism Vol. 86, No. 8 3480-3487.;86/8/3480

Falutz J et al. Metabolic effects of a Growth Hormone–Releasing Factor in patients with HIV. NEJM Volume 357:2359-2370. December 6, 2007. Number 23.

Falutz J et al. Long-term safety and effects of tesamorelin, a growth hormone-releasing factor analogue, in HIV patients with abdominal fat accumulation. AIDS: 12 September 2008 – Volume 22 – Issue 14 – p 1719-1728, doi: 10.1097/QAD.0b013e32830a5058.,_a.6.aspx

Theratechnologie Press Release. Theratechnologies Provides Regulatory Update on Tesamorelin. (22 June 2012). (PDF)

Gervasoni C et al. Long-term efficacy of the surgical treatment of buffalo hump in patients continuing antiretroviral therapy. Research letter. AIDS: 20 February 2004 – Volume 18 – Issue 3 – pp 574-576.

Grunfeld C et al. Recombinant human growth hormone to treat HIV-associated adipose redistribution syndrome: 12-week induction and 24-week maintenance therapy. JAIDS: 1 July 2007 – Volume 45 – Issue 3 – pp 286-297, doi: 10.1097/QAI.0b013e31804a7f68.

Kotler D et al. Effects of growth hormone on abnormal visceral adipose tissue accumulation and dyslipidemia in HIV-infected patients. JAIDS: 1 March 2004 – Volume 35 – Issue 3 – pp 239-252.

Koutkia P et al. Growth Hormone–Releasing Hormone in HIV-infected men with lipodystrophy, a randomized controlled trial. JAMA. 2004;292:210-218.

Reilly MJ et al. Wound infection rates in elective plastic surgery for HIV-positive patients. Plastic & Reconstructive Surgery: January 2009 – Volume 123 – Issue 1 – pp 106-111, doi: 10.1097/PRS.0b013e3181904dd9.

Metformin caution

Kohli R et al. A randomized placebo-controlled trial of metformin for the treatment of HIV lipodystrophy. HIV Medicine, Volume 8, Issue 7, pages 420–426, October 2007.

Lipids – cholesterol and triglycerides

Armatige J. The safety of statins in clinical practice. Lancet 2007; 370: 1781–90. DOI:10.1016/S01406736(07)60716-8. Interes/2009/Enero 2009/Seguridad de las Estatinas en la practica Clinica Diaria Lancet 2007.pdf (PDF)

Calza L et al. Statins and fibrates for the treatment of hyperlipidaemia in HIV-infected patients receiving HAART. AIDS: 11 April 2003 – Volume 17 – Issue 6 – pp 851-859.

Chou D et al. Short-term ezetimibe is well tolerated and effective in combination with statin therapy to treat elevated LDL cholesterol in HIV-infected patients. AIDS: 23 October 2009 – Volume 23 – Issue 16 – p 2133-2141 doi: 10.1097/QAD.0b013e32833068e3.

De Truchis P et al. Reduction in triglyceride level with N-3 polyunsaturated fatty acids in HIV-infected patients taking potent antiretroviral therapy: a randomized prospective study. JAIDS: 1 March 2007 – Volume 44 – Issue 3 – pp 278-285, doi: 10.1097/QAI.0b013e31802c2f3d.

Dubé MP et al, Safety and efficacy of extended-release niacin for the treatment of dyslipidaemia in patients with HIV infection: AIDS Clinical Trials Group Study A5148. Antiviral Therapy11:1081–1089.

ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal (June 2011) doi: 10.1093/eurheartj/ehr158

Gerber JG et al. Fish oil and fenofibrate for the treatment of hypertriglyceridemia in HIV-infected subjects on antiretroviral therapy, results of ACTG A5186. JAIDS: 2008, April 1; 47(4): 459–466. doi: 10.1097/QAI.0b013e31815bace2.

Kotler D. Lipid abnormalities and associated cardiovascular risk in HIV-infected patients. JAIDS: 1 September 2008 – Volume 49 – Issue – pp S79-S85, doi: 10.1097/QAI.0b013e318186519c.

Law M et al. Statin safety: a systematic review. Am J Cardiol. 2006 Apr 17;97(8A):52C-60C. Epub 2006 Feb 3.

Boffito M et al. Plasma exposure of 100 mg once and twice daily decreases HDL and CD36 expression but only twice-daily dosing increases triglycerides: potential effect of ritonavir on cardiovascular disease. 15th CROI, 3–6 February 2008, Boston. Poster abstract 930.

McGoldrick C et al. The management of dyslipidaemias in antiretroviral-treated HIV infection: a systematic review. HIV Medicine, Volume 8, Issue 6, pages 325–334, September 2007.

Moyle GJ et al. Dietary advice with or without pravastatin for the management of hypercholesterolaemia associated with protease inhibitor therapy. AIDS 2001;15:1503–1508.

Negredo E et al. Ezetimibe, a promising lipid-lowering agent for the treatment of dyslipidaemia in HIV-infected patients with poor response to statins. AIDS:, 14 November 2006 – Volume 20 – Issue 17 – p 2159-2164, doi: 10.1097/01.aids.0000247573.95880.db.,_a_promising_lipid_lowering_agent_for.4.aspx

Nordestgaard BG et al. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007;298:299-308.

PI switch to ATZ for lipids

Rubio R et al. Effect of simplification from protease inhibitors to boosted atazanavir-based regimens in real-life conditions. HIV Medicine, Volume 11, Issue 9, pages 545–553, October 2010.

Scevola D et al. Effect of exercise and strength training on cardiovascular status in HIV-infected patients receiving highly active antiretroviral therapy. AIDS 2003 (April), 17 (suppl 1):S123 – S129.

Worm S et al. Triglycerides and the risk of myocardial infarction in the D:A:D study. 17th CROI, 16–19 February 2010, San Francisco. Oral abstract 127.

Insulin resistance and diabetes

Achhra AC et al. Impact of short-term change in body mass index after antiretroviral therapy initiation on subsequent risk of cardiovascular disease and diabetes in HIV-positive individuals: the D:A:D study. 20th International AIDS Conference, 20-25 July 2014, Melbourne. Oral abstract WEAB0103. (abstract) (webcast)

Blümer R et al. Zidovudine/lamivudine contributes to insulin resistance within 3 months of starting combination antiretroviral therapy. AIDS: 11 January 2008 – Volume 22 – Issue 2 – p 227-236, doi: 10.1097/QAD.0b013e3282f33557.

Driscoll SD et al. Effects of exercise training and metformin on body composition and cardiovascular indices in HIV-infected patients. AIDS: 20 February 2004 – Volume 18 – Issue 3 – pp 465-473.

Ryan JG. Increased risk for type 2 diabetes mellitus with HIV-1 infection. Insulin Journal. Volume 5 Number 1.

Samaras K et al. Prevalence and pathogenesis of diabetes mellitus in HIV-1 infection treated with combined antiretroviral therapy. JAIDS: April 2009 – Volume 50 – Issue 5 – pp 499-505, doi: 10.1097/QAI.0b013e31819c291b.

Tebas P. Insulin resistance and diabetes mellitus associated with antiretroviral use in HIV-infected patients: pathogenesis, prevention and treatment options. JAIDS: 1 September 2008 – Volume 49 – Issue – pp S86-S92, doi: 10.1097/QAI.0b013e31818651e6.

HIV and ageing

Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 2009; 338:a3172 doi: 10.1136/bmj.a3172 (Published 26 January 2009).

Murphy G and Youle M. Coming of Age: a guide to ageing well with HIV

Heart disease

McLaughlin MM et al. Association of viral persistence and atherosclerosis in adults with treated HIV infection JAMA Netw Open. 2020.

Silverberg MJ et al. Initial antiretroviral therapy regimen and risk of heart failure. AIDS ():10.1097/QAD.0000000000003786, November 14, 2023. | DOI: 10.1097/QAD.0000000000003786.

Ghazi L et al. Role of Inflammatory Biomarkers in the Prevalence and Incidence of Hypertension Among HIV-Positive Participants in the START Trial. Am J Hypertens. 2020 Jan 1;33(1):43-52. doi: 10.1093/ajh/hpz132.

Byonanebye DM et al. Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Med. 2022 Sep;23(8):895-910. doi: 10.1111/hiv.13273. Epub 2022 Mar 1.

Collins S. Statin use in HIV positive people. HTB April 2013.

Sabin C et al. Is there continued evidence for an association between abacavir and myocardial infarction risk? 21st CROI, 3-6 March 2014, Boston. Poster abstract 747 LB.

British Cardiac Society/British Hypertension Society/Diabetes UK/Heart UK/Primary Care Cardiovascular Society (2005) JSB2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart 91: 1–52.

Crane HM et al. Lipoatrophy and lipohypertrophy (belly fat not associated after BMI factored in) are independently associated with hypertension. HIV Medicine, Early View May 2009.

El-Sadr WM et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med2006;355:2283-96.

Grinspoon S and Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 2005; 352:48-62January 6, 2005.

Grunfeld C et al. HIV infection Is an independent risk factor for atherosclerosis similar in magnitude to traditional cardiovascular disease risk factors. 16th CROI 2009. Oral abstract 146.

Hsue P et al. HIV infection is independently associated with detectable coronary artery calcium. 16th CROI 2009. Poster abstract 724.

Kloner RA. Cocaine and the Heart. N Engl J Med 2003; 348:487-488, February 6, 2003.

Lundgren J et al. Risk of Myocardial infarction with exposure to specific ARV from the PI, NNRTI, and NRTI drug classes: the D:A:D study. 16th CROI, 8–11 February 2009, Montreal. Oral late breaker abstract 44LB.

Modrich L et al. Factors associated with mortality in the study of fat redistribution and metabolic change in HIV infection. 16th CROI 2009. Poster abstract 706.

Petoumenos K et al. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study. 17th CROI, 16–19 February 2010, San Francisco. Oral abstract 124.

Reiss P. Abacavir and cardiovascular risk. 16th CROI. Oral abstract 152.

Ford ES et al. Traditional risk factors and D-dimer predict incident cardiovascular disease events in chronic HIV infection. AIDS: 19 June 2010 – Volume 24 – Issue 10 – p 1509-1517 doi: 10.1097/QAD.0b013e32833ad914.

Bone health

National (US) Osteoporosis Foundation 2008 guidelines

Royal National Osteoporsis Society (UK)

Bone Research Society

Grant PM et al. Long-term Bone Mineral Density Changes in Antiretroviral-Treated HIV-Infected Individuals. Brief report. JID (22 June 2016). DOI: 10.1093/infdis/jiw204.

Hoy JF et al. Effects of immediate versus deferred initiation of antiretroviral therapy on bone mineral density: a substudy of the INSIGHT strategic timing of antiretroviral therapy (START) study. 15th European AIDS Conference, October 21-24, 2015, Barcelona. Abstract ADRLH-62.

Hoy J et al. Changes in bone mineral density over 48 weeks among participants randomised to either lopinavir/ritonavir (LPV/r) + 2-3N(t)RTI or LPV/r + raltegravir as second-line therapy: a sub-study of the SECONDLINE trial. 7th IAS Conference, Kuala Lumpar, 2013, Late breaker oral abstract WELBB05.

Brown TT et al. Recommendations for Evaluation and Management of Bone Disease in HIV. CID 60(8):1242–1251. (15 April 2015).

Mallon PWG and Brown TT (Editors). Bone complications in HIV/AIDS. Current Opinion in HIV & AIDS. May 2016 – Volume 11 – Issue 3.

Erlandson KM et al. More than osteoporosis: age-specific issues in bone health. Current Opinion in HIV & AIDS. May 2016 – Volume 11 – Issue 3 – p 343–350. doi: 10.1097/COH.0000000000000258.

Corrilynn HO et al. Is bone loss linked to chronic inflammation in antiretroviral-naïve HIV-infected adults? A 48-week matched cohort study. AIDS (2014), 28: 1759-1767. (PDF)

Sherwood JE et al. Vitamin D deficiency and its association with bone low mineral density, HIV-related factors, hospitalization, and death in a predominantly black HIV-infected cohort. Clin Infect Dis (2012), 55: 1727-1736

El-Maouche D et al. Vitamin D deficiency and its relation to bone mineral density and liver fibrosis in HIV-HCV coinfection. Antivir Ther (2013), 18: 237-242 (PDF)

Morse CG et al. Elevations in D-dimer and C-reactive protein are associated with the development of osteonecrosis of the hip in HIV-infected adults. AIDS 27(4):591–595. 20 February 2013. doi: 10.1097/QAD.0b013e32835c206a.

Grijsen M et al. Low bone mineral density in men who have sex with men regardless of HIV status. J Infect Dis. (2012) doi: 10.1093/infdis/jis687. First published online: November 12, 2012 (PDF full text)

Dao C et al. Higher and increasing rates of fracture among HIV-infected persons in the HIV Outpatient Study compared to the general US population, 1994 to 2008. 17th CROI. 16-10 February 2010, San Francisco. Oral abstract 128.

Rozenberg S et al. Effect of alendronate on HIV-related osteoporosis: a randomised, double-blind, placebo-controlled trial (ANRS 120). 12th EACS, 11-14 November 2009, Cologne. Abstract PS5/4. 2.

McComsey G et al. Alendronate with calcium and vitamin D supplementation is safe and effective for the treatment of decreased bone mineral density in HIV. AIDS: 30 November 2007 – Volume 21 – Issue 18 – p 2473-2482 doi: 10.1097/QAD.0b013e3282ef961d.

McComsey G et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clinical Infectious Diseases 2010; 51(8):937–946 (15 October). doi: 10.1086/656412.

Mondy K et al. Alendronate, vitamin D, and calcium for the treatment of osteopenia/osteoporosis associated with HIV infection. JAIDS,1 April 2005 – Volume 38 – Issue 4 – pp 426-431.,_Vitamin_D,_and_Calcium_for_the.7.aspx

Mundy L et al. Overall benefit of antiretroviral treatment on the risk of fracture in HIV: nested case–control analysis in a health-insured population. AIDS. 26(9):1073-1082, June 1, 2012.

Yin MT et al. Fracture incidence in HIV-infected women: results from the Women’s Interagency HIV Study. AIDS: 20 September 2010 doi: 10.1097/QAD.0b013e32833f6294.

Grund B. Continuous antiretroviral therapy decreases bone mineral density. AIDS: 31 July 2009 – Volume 23 – Issue 12 – p 1519-1529 doi: 10.1097/QAD.0b013e32832c1792.

Borderi M. Editorial Review. Metabolic bone disease in HIV infection. AIDS: 17 July 2009 – Volume 23 – Issue 11 – p 1297-1310 doi: 10.1097/QAD.0b013e32832ce85a.

Huang J. A double-blinded, randomized controlled trial of zoledronate therapy for HIV-associated osteopenia and osteoporosis. AIDS: 2 January 2009 – Volume 23 – Issue 1 – p 51-57 doi: 10.1097/QAD.0b013e32831c8adc.,_randomized_controlled_trial_of.8.aspx

HIV and cancer

Piketty C et al. Lack of regression of anal squamous intrapathelial lesions despite immune restoration under cART. AIDS. 2013 Jan 28;27(3):401-6. doi: 10.1097/QAD.0b013e32835ad2cb.

Petoumenos K et al. Cancer, immunodeficiency and antiretroviral treatment: results from the Australian HIV Observational Database (AHOD). HIV Medicine. 2013 Feb 14(2):77-84. doi: 10.1111/j.1468-1293.2012.01038.x.

NIH/IDSA Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, 10 April 2009.

Engels EA et al. Cancer risk in people infected with Human Immunodeficiency Virus in the United States. International Journal of Cancer 2008; 123(1):187-194.

Kikuchi L et al (Liver Cancer in HIV Study Group). Impact of screening for hepatocellular carcinoma (HCC) in HIV/HCV-coinfected patients on staging, therapy and survival. 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010). Vienna, Austria. April 14-18, 2010. (Abstract).

Bedimo RJ et al. Incidence of non-AIDS-defining malignancies in HIV-infected versus noninfected patients in the HAART era: impact of immunosuppression. J Acquir Immune Defic Syndr. 2009.

Bratcher J, Palefsky J. Anogenital Human Papillomavirus coinfection and associated neoplasia in HIV-positive men and women. PRN Notebook, Volume 13, 2008.

Guiguet M et al. Effect of immunodeficiency, HIV viral load, and antiretroviral therapy on the risk of individual malignancies (FHDH-ANRS CO4): a prospective cohort study. Lancet Oncology. 2009.

d’Arminio Monforte A et al for D:A:D study. HIV-induced immunodeficiency and mortality from AIDS-defining and non-AIDS-defining malignancies. AIDS: 18 October 2008 – Volume 22 – Issue 16 – p 2143-2153 doi: 10.1097/QAD.0b013e3283112b77.

Grulich AE et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370(9581):59-67.

Sigel K et al. HIV infection is an independent risk factor for lung cancer. 17th CROI. 16-10 February 2010, San Francisco. Oral Abstract 30.

Bower M. Screening for non-AIDS malignancies: if and how? 12th EACS, 11-14 November, 2009, Cologne. Webcast:

Lifestyle changes: diet, exercise, smoking, alcohol

ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal (2011) 32, 1769–1818 doi:10.1093/eurheartj/ehr158. (PDF file)

Estruch R et al. Primary prevention of cardiovascular disease with a mediterranean diet. N Engl J Med 2013; 368:1279-1290.DOI: 10.1056/NEJMoa1200303. (04 April 2013)

Goodarz D et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Medicine, Volume 6, Issue 4. (02 April 2009)

Dietary reference values for energy, scientific advisory committee on nutrition, 2011

Fruit and vegetables for health, report of a joint FAO/WHO workshop, 1-3 September 2004, Kobe, Japan.

Food Standard Agency (FSA) and Food Based Guidelines for UK Institutions (October 2008). (PDF file)

US Centre for Disease Control (CDC). Americans consume too much sodium (Salt).
Healy GN et al. Objectively measured sedentary time, physical activity, and metabolic risk: the Australian diabetes, obesity and lifestyle study (AusDiab). Diabetes Care vol. 31 no. 2 pages 369-371. (February 2008).

Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity (2010) 7:40. doi:10.1186/1479-5868-7-40

Lee CD et al. Physical activity and stroke risk, a meta-analysis. Stroke. 2003; 34: 2475-2481.

WHO. Global recommendations on physical activity for health. (2006)

Trøseid M et al. Reduced trunk fat and triglycerides after strength training are associated with reduced LPS levels in HIV-infected individuals. JAIDS. 2014 Jun 1;66(2):e52-4.

Fazeli PL et al. An active lifestyle is associated with better neurocognitive functioning in adults living with HIV infection. Journal of Neurovirology. 2014 Jun;20(3):233-42.

Mapstone M et al. Poor aerobic fitness may contribute to cognitive decline in HIV-infected older adults. Aging and Disease. 2013 Aug 27;4(6):311-9.  (abstract) (free full text)

Dufour CA et al. Physical exercise is associated with less neurocognitive impairment among HIV-infected adults. Journal of Neurovirology. 2013 Oct;19(5):410-7.

Mattson MP. Exercise and the brain: a slap on the HAND. Editorial. J. Neurovirol. (2013) 19:407–409 DOI 10.1007/s13365-013-0208-4.  (PDF)
Helleberg M et al. Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. AIDS (14 January 2015), 29: 221 – 9.

Helleberg m et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis (2013), 56:727–734.

Cahill K et al. 2012. Can nicotine receptor partial agonists, including cytisine, dianicline and varenicline, help people to stop smoking? Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub6


Canadian Centre on Substance Use and Addiction. Guidance on Alcohol and Health: Final Report and Infographic. Published online . (17 January 2023).

Justice AC et al. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug and Alcohol Dependence. Jan 2016. (16) 00045-4. (PDF)

Akgun KM et al. Risk factors for hospitalization and medical intensive care unit (MICU) admission among HIV-infected Veterans. J. Acquir. Immune. Defic. Syndr. 2013. (62) 52-59 (PDF)

McGinnis KA. Number of drinks to “feel a buzz” varies by HIV Status and viral load in men. AIDS Behav. 2015. 1-8.

Braithwaite RS and Bryant KJ. Influence of alcohol consumption on adherence to and toxicity of antiretroviral therapy and survival. Alcohol Res. Health. 2010. (33) 280-287. (PDF)

Last updated: 1 February 2024.