If you’ve recently been diagnosed with human immunodeficiency virus (HIV), you may have a lot to process. And if you’ve heard stories about HIV medications causing difficult side effects, starting treatment can feel scary.

The good news is that today’s medications are generally much easier to take and tolerate than older treatments. Many people have few side effects, and when side effects do arise, they’re often mild or improve with time.

Starting HIV treatment (called antiretroviral therapy, or ART) as soon as possible helps protect your immune system and keep you healthy. Once treatment brings HIV down to an undetectable level and it stays there, you won’t sexually transmit HIV to others. This is known as Undetectable = Untransmittable, or U=U.

If fear of side effects is making you hesitate, here’s what you should know.

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Today’s HIV Treatment Is Different

Some of the reputation HIV medications have for severe side effects comes from older drugs. Earlier treatments could involve taking lots of pills, and those treatments were sometimes linked to serious stomach problems, changes in body fat, kidney problems, nerve damage, and other side effects.

Those experiences were real, but they don’t reflect what most people starting HIV treatment can expect today. Current treatments are generally easier to take and tolerate. For many people, treatment includes an integrase inhibitor — a drug that blocks an HIV enzyme the virus needs to multiply, such as bictegravir or dolutegravir (Tivicay). Integrase inhibitors often come in a single daily pill.

Your doctor will also consider factors when choosing treatment, including:

• Your overall health
• Other medications you’re taking
• Possible drug resistance
• Your pregnancy status

The goal is to find an option that works well for you and fits your health needs.

What Are the Possible Side Effects?

Every medication can cause side effects, but that doesn’t mean you’ll experience them. With modern HIV treatment, possible side effects include:

• Headache
• Nausea
• Diarrhea
• Tiredness
• Dizziness
• Sleep changes

Side Effects With Common HIV Treatments

Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) is a once-daily treatment. In clinical trials, the most commonly reported side effects were diarrhea, nausea, and headache. One percent of participants stopped Biktarvy because of side effects through week 144.

Other common HIV treatments use dolutegravir as part of a combination of medicines. These treatments are also generally well tolerated, although headache, insomnia, and other sleep problems can occur.

Some side effects improve as your body adjusts to treatment. If they don’t, your healthcare team can help figure out whether your medication is causing them and what might help.

What About Weight Gain?

Weight gain has received increasing attention with modern HIV treatment, particularly with some integrase inhibitor-based treatments and treatments containing tenofovir alafenamide (TAF).

Research suggests some people starting these treatments may gain more weight than people taking certain older treatments. In one trial, weight gain was greater among participants taking dolutegravir, particularly when combined with TAF.

Not Everyone Gains Weight

That doesn’t mean everyone will gain a lot of weight. Some people gain little or none. Some weight gain may also reflect a “return-to-health” effect as HIV comes under control, especially if someone lost weight beforehand.

Researchers are continuing to study why some people appear more likely to gain weight and what these changes mean for long-term health.

If weight is a concern, tell your doctor. Your care team can track changes and help you manage your weight over time. If you’re thinking about switching HIV treatments because of weight gain, it’s worth knowing that switching HIV medicines specifically to reduce weight gain is not reliably effective.

Don’t Stop HIV Medication on Your Own

If you start ART and develop nausea, headaches, trouble sleeping, or another problem, contact your HIV care team rather than skipping or stopping your medication. Interrupting treatment can allow HIV to start multiplying again and may contribute to drug resistance.

Side effects are often manageable. Your care team may suggest changing when you take your medication, checking for interactions, or treating the symptom itself. They can also look for other possible causes, since not every new symptom after starting ART is caused by HIV medication.

If a side effect continues to bother you, another HIV treatment may be a better fit. You don’t have to choose between controlling HIV and living with side effects that significantly affect your life.

When Should You Get Urgent Help?

Serious reactions to modern HIV medications are rare, but some symptoms need medical attention right away.

Seek urgent medical care for:

• Difficulty breathing
• Swelling of the face, lips, tongue, or throat
• A severe or rapidly worsening rash, especially with blistering, peeling skin, mouth sores, or fever

Contact a healthcare professional if you have yellowing of the skin or eyes, unusually dark urine, severe or ongoing abdominal pain, new or worsening depression, major mood changes, or thoughts of self-harm. If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or using the online chat.

Rarely, people receiving cabotegravir/rilpivirine can have a reaction within minutes of an injection, including trouble breathing, agitation, abdominal cramping, flushing, sweating, or dizziness. These injections are given by healthcare professionals. Serious reactions are uncommon, and modern HIV treatment is generally safe and well tolerated.

Put the Risks in Perspective

It’s natural to focus on what might happen after taking a new medication. But leaving HIV untreated also carries risks.

Without ART, HIV continues attacking immune cells, which can weaken your immune system and raise your risk of serious infections and other health problems. Effective treatment keeps HIV from progressing and greatly reduces HIV-related illness and death. Starting treatment sooner also helps protect your immune system.

Treatment can prevent HIV from being passed through sex, too. People who take ART as prescribed and maintain an undetectable viral load have zero risk of passing HIV to a sexual partner. That’s the idea behind U=U and one reason treatment is recommended for everyone with HIV.

Find a Treatment That Works for You

If side effects are worrying you, talk with your doctor before starting treatment. Ask which side effects are most likely, which ones may improve with time, and what other options are available if a treatment isn’t a good fit.

Tell your care team which side effects you’re most concerned about. Maybe you already struggle with insomnia, you’re worried about weight changes, or you take other medications and want to avoid interactions. Those details can help guide treatment choices.

HIV treatment isn’t one-size-fits-all. There are several highly effective options, and your care team can consider your health, other medications, preferences, and daily routine when recommending one.

Don’t let stories about older HIV medications define what you expect from treatment today. For many people, ART becomes an ordinary part of life while doing something very important: keeping HIV under control.