Key Points

• HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission. But HIV medicines can sometimes cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious.
• Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV medicines cause fewer side effects than medicines used in the past. As HIV treatment continues to improve, people are less likely to have side effects from HIV medicines.
• Different HIV medicines can cause different side effects. In addition, people taking the same HIV medicine can have different side effects.
• People starting HIV medicines can talk to their health care provider about possible side effects and ways to manage them.

Can HIV medicines cause side effects?

HIV medicines help people with HIV live longer, healthier lives. HIV medicines also reduce the risk of HIV transmission. But HIV medicines can sometimes cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious.

Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV medicines cause fewer side effects than medicines used in the past. As HIV treatment continues to improve, people are less likely to have side effects from HIV medicines.

Before starting HIV medicines, people with HIV discuss possible side effects from HIV medicines with their health care providers. They work together to select an HIV treatment regimen based on the person’s individual needs.

Do all HIV medicines cause the same side effects?

Different HIV medicines can cause different side effects. In addition, people taking the same HIV medicine can have different side effects.

Side effects from HIV medicines may last only a few days or weeks. For example, nausea, fatigue, and trouble sleeping are some short-term side effects of HIV medicines.

Other side effects from some HIV medicines can lead to problems that may not appear for months or years after starting a medicine. For example, high cholesterol can be a side effect of some HIV medicines. High cholesterol is a risk factor for heart disease.

Having another medical condition or taking other medicines can increase the risk of side effects from HIV medicines. Drug-drug interactions between HIV medicines or with other medicines a person is taking can also cause side effects.

What are some ways to manage side effects from HIV medicines?

Before starting HIV medicines, talk to your health care provider about possible side effects.

Depending on the HIV medicines in your HIV treatment regimen, your health care provider will:

• Tell you which specific side effects to look out for.
• Give you suggestions on how to deal with side effects that are manageable. For example, to manage nausea and vomiting, eat small meals and avoid spicy foods.
• Tell you about the signs of life-threatening side effects that require immediate medical care. One example is swelling of the mouth and tongue.

Once you start taking HIV medicines, tell your health care provider about any side effect that you are having. Your health care provider can recommend ways to treat or manage the side effect.

In some cases, it may be necessary to change HIV medicines because of a side effect. However, do NOT cut down on, skip, or stop taking your HIV medicines unless your health care provider tells you to. Fortunately, there are many HIV medicines available to include in an HIV treatment regimen. The choice of HIV medicines to replace those causing side effects will depend on a person’s individual needs.

What is diabetes?

Diabetes is a disease that develops when levels of glucose in the blood (also called blood sugar) are too high. Glucose comes from the breakdown of the foods we eat and is our main source of energy.

Over time, diabetes can cause serious health problems, including heart disease, stroke, kidney disease, eye problems, and nerve damage.

There are different types of diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes. This fact sheet discusses type 2 diabetes, which is the most common type of diabetes.

What are the risk factors for type 2 diabetes?

Risk factors for type 2 diabetes include being 45 years of age or older, having a family history of diabetes, being overweight or obese, and lack of physical activity. People whose family background is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American are at greater risk of type 2 diabetes.

People with HIV are more likely to have type 2 diabetes than people without HIV. Additionally, some HIV medicines may increase the risk of type 2 diabetes in people with HIV.

What are the symptoms of diabetes?

The symptoms of diabetes can include:

• Increased thirst
• Frequent urination
• Increased hunger
• Unusual weight loss
• Fatigue
• Blurred vision
• Tingling or numbness in the hands or feet
• Sores that do not heal

People who have symptoms of diabetes should get tested for the disease. Testing is also recommended for people with certain risk factors for diabetes. Blood tests are used to measure blood glucose levels and diagnose diabetes.

Should people with HIV get tested for diabetes?

People with HIV should have their blood glucose levels checked before starting treatment with HIV medicines. People with higher-than-normal glucose levels may need to avoid taking some HIV medicines.

Blood glucose testing is also important after starting HIV medicines. If testing shows high glucose levels, a change in HIV medicines may be necessary.

How can a person prevent, delay, or manage type 2 diabetes?

You can take the following steps to lower your risk of developing type 2 diabetes:

• Maintain a healthy weight. If you are overweight, lose weight and keep it off.
• Eat healthy. Eat a variety of healthy foods and limit foods high in fat, sugar, and salt.
• Keep moving. Aim for 30 minutes of physical activity on most days of the week.

People who have type 2 diabetes can also follow these steps to manage the disease. In addition, some people may take medicine to manage their type 2 diabetes.

If you have HIV, talk to your health care provider about your risk for diabetes.

What is heart disease?

There are many different types of heart disease. Coronary heart disease (also called coronary artery disease) is the most common type of heart disease. It is the leading cause of death in the United States. In this fact sheet, the term “heart disease” refers specifically to coronary heart disease.

What causes heart disease?

Heart disease is caused by the buildup of plaque inside the blood vessels that carry blood to the heart (called the coronary arteries). Plaque is a waxy substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque buildup in the coronary arteries (called atherosclerosis) reduces the blood flow to the heart, which can cause chest pain (called angina) or a heart attack.

What are the risk factors for heart disease?

Some risk factors for heart disease can be changed or controlled by lifestyle changes or medicines, while other risk factors cannot. Risk factors that can be controlled to prevent or delay heart disease include the following:

• High blood pressure (also known as hypertension)
• High blood cholesterol levels
• Diabetes
• Eating an unhealthy diet
• A lack of physical activity
• Smoking
• Being overweight or obese
• Stress

Risk factors for heart disease that cannot be changed include having a family history of early heart disease and older age.

Are people with HIV at risk for heart disease?

Yes. The risk factors for heart disease are the same for people with HIV and people without HIV. However, HIV infection and some HIV medicines may increase the risk of heart disease in people with HIV.

Research is underway to understand the connection between HIV and heart disease.

What are the symptoms of heart disease?

Some people who have heart disease have no symptoms. However, some people may have chest pain, shortness of breath, fatigue, or weakness. If you have any of these symptoms, contact your health care provider.

Chest pain that does not go away or occurs while a person is resting may be a sign of a heart attack. If you think you may be having a heart attack, call 9-1-1 immediately.

What is the treatment for heart disease?

Treatment for heart disease often includes lifestyle changes. For example, people with heart disease may change their eating habits, exercise more to lose weight, or quit smoking.

Medicines and surgery are also used to treat heart disease.

Medicines
Medicines used to treat heart disease include drugs to lower blood pressure, reduce cholesterol levels, or prevent or relieve chest pain. Some of these medicines may interact with HIV medicines. Health care providers carefully consider potential drug interactions between HIV medicines and any other medicines a person may be taking.

Surgery
Coronary artery bypass grafting (CABG) is the most common type of surgery to treat heart disease in adults. During CABG, a healthy artery or vein from the body is used to bypass (go around) the blocked part of a coronary artery.

How can people with HIV reduce their risk of heart disease?

People with HIV can take the following steps to reduce their risk of heart disease:

• Take HIV medicines every day to keep HIV under control.
• Eat a healthy diet that includes lots of vegetables, fruits, and whole grains, and is low in saturated fats, added sugars, and salt.
• Be physically active on a regular basis.
• Quit smoking.
• Keep all medical appointments. During medical visits, talk to a health care provider about the risk of heart disease.

What is high cholesterol?

High cholesterol (also called hyperlipidemia) refers to high levels of cholesterol in the blood. Cholesterol is a waxy, fat-like substance made by the body. Cholesterol is also found in foods from animal sources, including egg yolks, meat, and cheese.

The body needs cholesterol to function properly, but having too much can cause problems. High cholesterol increases the risk of heart disease.

What are risk factors for high cholesterol?

The most common causes of high cholesterol are unhealthy lifestyle habits, including the following:

• Eating foods high in saturated fat, trans fat, and cholesterol
• Lack of physical activity
• Smoking

The following are additional risk factors for high cholesterol:

• Age—as people get older, their cholesterol levels tend to rise
• A family history of high cholesterol
• Other medical conditions, such as diabetes
• Being overweight or obese
• Certain medicines

Some HIV medicines may also increase the risk of high cholesterol in people with HIV.

What are the symptoms of high cholesterol?

Usually high cholesterol has no symptoms. A blood test is used to measure cholesterol levels.

Cholesterol testing is recommended before and after a person starts taking HIV medicines. If cholesterol levels are normal, testing is recommended once a year. If cholesterol levels are too high, more frequent testing is recommended.

What steps can a person take to prevent high cholesterol?

People can take these steps to prevent high cholesterol or lower cholesterol levels.

• Eat a healthy diet. Eat foods low in saturated fat, trans fat, and cholesterol. Choose low-fat or fat-free dairy products, eat more foods that are high in fiber, and eat more vegetables and fruits.
• Get active. Try to get at least 30 minutes of physical activity on most days of the week.
• Maintain a healthy weight. If you are overweight or obese, losing weight can improve cholesterol levels.
• Quit smoking.To find tips and tools to help you quit smoking, visit the Department of Health and Human Services’ Smokefree.gov website.

What is the treatment for high cholesterol?

Treatment for high cholesterol begins with lifestyle changes. Sometimes cholesterol-lowering medicine is also needed. The most common medicines used to reduce cholesterol levels are called statins.

In people with HIV, treatment for high cholesterol may include changing an HIV regimen to avoid taking HIV medicines that can increase cholesterol levels.

Some HIV medicines can interact with medicines that lower cholesterol levels. Health care providers carefully consider potential drug interactions between HIV medicines and any other medicines a person may be taking.

What are the kidneys and what do they do?

The kidneys are two fist-sized organs in the body. They are located near the middle of the back on either side of the spine.

The main job of the kidneys is to filter harmful waste and extra water from the blood. The waste and water become urine, which is flushed from the body. The kidneys also release hormones that help control blood pressure, make red blood cells, and keep bones strong.

Kidney function declines as people age. Injury or disease, including HIV infection, can also damage the kidneys. Damage to the kidneys can lead to kidney disease (also called renal disease). Kidney disease can advance to kidney failure.

What are the causes of kidney disease?

Diabetes and high blood pressure are the leading causes of kidney disease. Other factors that increase the risk of kidney disease include heart disease and a family history of kidney disease or kidney failure.

A person's risk of kidney disease increases as they get older. The longer a person has diabetes, high blood pressure, or heart disease, the greater their risk of kidney disease.

The risk of kidney failure is especially high among African Americans, Hispanics, and American Indians, partially because these communities have high rates of diabetes and high blood pressure.

Are people with HIV at risk for kidney disease?

The risk factors for kidney disease in people with HIV include all those listed above. In addition, poorly controlled HIV infection and coinfection with the hepatitis C virus (HCV) increase the risk of kidney disease in people with HIV.

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People on ART take a combination of HIV medicines (called an HIV regimen) every day. ART is recommended for everyone who has HIV. Some HIV medicines can affect the kidneys. Health care providers carefully consider the risk of kidney damage when recommending specific HIV medicines to include in an HIV regimen. If a person on ART shows signs of kidney disease, the type or dose of HIV medicine in their HIV regimen may change.

What are the symptoms of kidney disease?

Kidney disease can advance very slowly. Slowly worsening kidney disease is called chronic kidney disease. Chronic kidney disease may not cause symptoms for many years.

As kidney disease gets worse, a person may have swelling of the legs, feet, or ankles (called edema). Symptoms of advanced chronic kidney disease can include:

• Increased or decreased urination
• Feeling tired or having trouble sleeping
• Nausea and vomiting
• Itching or numbness

Blood and urine tests are used to detect kidney disease. Care for people with HIV includes testing for kidney disease.

What is the treatment for kidney disease?

People with kidney disease can take steps to protect their kidneys from further damage. For example, many people with kidney disease take medicines to control high blood pressure. They may also reduce the amount of salt and protein in their diet to manage their kidney disease.

Some people live with kidney disease for many years; in others, kidney disease progresses to kidney failure. The treatments for kidney failure are dialysis and a kidney transplant. Both treatments take over the job of the failed kidneys.

• There are two types of dialysis. Like the kidneys, both types filter harmful waste and extra water out of the blood. In hemodialysis, a machine outside of the body is used to filter the blood. In peritoneal dialysis, the lining of the abdomen filters the blood inside the body.
• A kidney transplant is surgery to place a healthy kidney from a donor into the body of a person with kidney failure. The donated kidney can be from a person who just died or from a living person.

Both dialysis and a kidney transplant are used to treat kidney failure in people with HIV.

How can people with HIV reduce their risk of kidney disease?

People with HIV can take the following steps to reduce their risk of kidney disease:

• Take HIV medicines every day to keep HIV under control.
• Eat a healthy diet that includes fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Cut back on foods high in salt and sugar.
• Be physically active for 30 minutes or more on most days.
• Keep all medical appointments. During medical visits, talk to a health care provider about the risk of kidney disease.

What is lipodystrophy?

Lipodystrophy refers to the changes in body fat that can affect some people with HIV. Lipodystrophy can include buildup of body fat, loss of body fat, or both.

Fat buildup (also called lipohypertrophy) can occur:

• Around the organs in the abdomen
• On the back of the neck between the shoulders (called a buffalo hump)
• In the breasts

Fat loss (also called lipoatrophy) tends to occur:

• In the arms and legs
• In the buttocks
• In the face

What causes lipodystrophy?

Lipodystrophy may be due to HIV infection or medicines used to treat HIV, but its actual cause is not understood. Newer HIV medicines are less likely to cause lipodystrophy than HIV medicines developed in the past.

Lipodystrophy is not a concern for most people who start HIV treatment now, because newer HIV medicines are less likely to cause lipodystrophy.

How is lipodystrophy treated?

If you have lipodystrophy, talk to your health care provider about treatment options. Your health care provider may recommend that you switch to another HIV medicine.

There are ways to manage lipodystrophy. Making dietary changes and getting regular exercise may help to build muscle and reduce abdominal fat.

Liposuction (surgical removal of fat) and injectable facial fillers are sometimes used to treat lipodystrophy. There are also medicines that may help lessen the effects of lipodystrophy.

What is hepatotoxicity?

Hepatotoxicity is the medical term for damage to the liver caused by a medicine, chemical, or herbal or dietary supplement. Hepatotoxicity can be a side effect of some HIV medicines.

Are there other factors that can increase the risk of hepatotoxicity?

The following factors may increase the risk of hepatotoxicity due to HIV medicines:

• Having hepatitis B virus (HBV) infection and/or hepatitis C virus (HCV) infection
• Taking other medicines that can cause liver damage
• Alcohol use, which can cause liver damage
• Pre-existing liver damage

What are the symptoms of hepatotoxicity?

Symptoms of hepatotoxicity include the following:

• Rash
• Stomach pain
• Nausea and vomiting
• Fatigue
• Dark-colored urine
• Light-colored bowel movements
• Jaundice (yellow skin and eyes)
• Loss of appetite
• Fever

People taking HIV medicines that may cause hepatotoxicity should know about these symptoms. In some cases, hepatotoxicity can be life-threatening. If you have any of these symptoms, contact your health care provider.

Are there tests to determine whether I am at risk for developing hepatotoxicity from HIV medicines?

Before starting HIV medicines, people with HIV have several lab tests done. These include blood tests to check for liver damage and for HBV and HCV infection. If the test results and other information shows that the person is at risk for developing hepatotoxicity, they can avoid HIV medicines that may cause hepatotoxicity.

How is hepatotoxicity treated?

Once a person starts taking HIV medicines, they are monitored for signs of hepatotoxicity. HIV medicines that are causing serious, life-threatening hepatotoxicity must be stopped immediately. However, a person should never stop taking an HIV medicine unless their health care provider tells them to.

Choosing an HIV medicine to replace one that is causing hepatotoxicity will depend on a person’s individual needs. Fortunately, there are many HIV medicines available to include in an HIV regimen.

If you are taking or plan to take HIV medicines, talk to your health care provider about the risk of hepatotoxicity.

Overview

HIV, or human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome) and can be transmitted during sexual intercourse; by sharing syringes; or perinatally during pregnancy, childbirth, or breastfeeding.

HIV weakens the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is important for fighting off infections. The loss of these cells means that people living with HIV are more vulnerable to other infections and diseases.

People living with HIV may be diagnosed with AIDS when they have one or more opportunistic infections (infections that occur because HIV weakens the immune system), such as pneumonia or tuberculosis, and have a very low number of CD4+ T cells (less than 200 cells per cubic millimeter of blood).

People with HIV/AIDS are at a higher risk for mental health disorders.

The stress associated with living with a serious illness or condition, such as HIV, can affect a person’s mental health. It is important for people living with HIV to know that they have a higher chance of developing mood, anxiety, and cognitive disorders. For example, depression is one of the most common mental health conditions faced by people living with HIV. It is important to remember that mental disorders are treatable. People who have a mental disorder can recover completely.

Situations that can contribute to mental health problems for people living with HIV include:

• Having trouble getting mental health services
• Experiencing a loss of social support, resulting in isolation
• Experiencing a loss of employment or worries about being able to perform at work
• Having to tell others about an HIV diagnosis
• Managing HIV medicines and medical treatment
• Dealing with loss, including the loss of relationships or the death of loved ones
• Facing stigma and discrimination associated with HIV/AIDS

HIV and related infections can also affect the brain and the rest of the nervous system. This may change how a person thinks and behaves. Also, some medications used to treat HIV may have side effects that affect a person's mental health.

Understanding how living with HIV can affect mental health and knowing what resources are available can make it easier for people to manage their overall health and well-being.

Central Nervous System Disease Associated with HIV

HIV causes significant inflammation in the body. This inflammation can cause neurological complications by damaging the spinal cord and brain, which make up the central nervous system.

Antiretroviral therapy (ART), a combination of HIV medications taken daily, helps stop HIV from replicating and spreading in the body. Despite effective ART, people living with HIV are still at risk for central nervous system diseases associated with HIV. These diseases can be neurological (affecting the nervous system) or neurocognitive (affecting cognition or mental processing).

Severe neurological impairments such as dementia, brain atrophy, and encephalitis (inflammation of the brain) are less common in people who use ART, compared to people living with HIV who are not on ART. However, there are still less severe forms of central nervous system diseases associated with HIV.

Researchers are working to better understand how HIV affects the central nervous system; this information will be helpful to develop new treatments to improve the lives of people living with HIV. Understanding which types of cells in the central nervous system are targeted by the HIV infection and how those cells are damaged may help shape efforts to prevent, treat, and cure HIV. Research efforts also focus on understanding why HIV is harder to eliminate in some tissues in the body and what strategies might be more effective on those cells.

HIV Treatments and Therapies

Research shows that HIV treatment should begin as soon as possible after diagnosis to achieve the best health outcomes. HIV treatment usually includes a combination of medicines called antiretroviral therapy (ART). Following a treatment plan, such as taking the medications prescribed by a health care provider, is critical for controlling and suppressing the virus. Following the treatment plan can be difficult, but there are strategies that can help.

Starting ART also can affect mental health in different ways. Sometimes ART can help to relieve anxiety because knowing that you are taking care of yourself can provide a sense of security. However, coping with the reality of living with a chronic illness like HIV can be challenging. In addition, some antiretroviral medicines may cause symptoms of depression, anxiety, and sleep disturbance and may make some mental health issues worse.

For these reasons, it is important for people living with HIV to talk to their health care provider about their mental health. A conversation about mental health should be part of a complete medical evaluation before starting ART, and discussions about mental health should continue throughout treatment.

People living with HIV should be open and honest with their provider about any changes in their mental health, such as thinking or how they feel about themselves and life in general. People living with HIV should also discuss any alcohol or substance use with their provider.

People living with HIV should also tell their health care provider about any over-the-counter or prescribed medications they may be taking, including any psychiatric medicines, because some of these drugs may interact with antiretroviral medications.

The Human Immunodeficiency Virus (HIV), which causes the disorder Acquired Immunodeficiency Syndrome (AIDS), primarily affects the immune system but also can lead to a wide range of severe neurological disorders, particularly if HIV goes untreated and progresses to AIDS. Many of the most severe neurological conditions can be prevented with antiretroviral therapy. HIV does not directly invade nerve cells (neurons) but puts their function at risk by infecting cells called glia that support and protect neurons. HIV also triggers inflammation that may damage the brain and spinal cord (central nervous system) and cause symptoms such as:

• Confusion and forgetfulness
• Inability to concentrate
• Behavioral changes
• Headaches
• Mood disorders (anxiety disorder and depression)
• Movement problems (loss of movement control) including a lack of coordination and difficulty walking

Damage to the peripheral nerves can cause progressive weakness and loss of sensation in the arms and legs. Research has shown that HIV infection can cause shrinking of brain structures involved in learning and information processing.

Other nervous system complications that can occur as a result of HIV infection or the drugs used to treat it include:

• Pain
• Seizures
• Strokes
• Shingles
• Difficulty swallowing
• Fever
• Vision loss
• Coma
• Problems with bladder control or sexual functioning

These symptoms may be mild in the early stages of AIDS but can become increasingly severe.

The nervous system may be affected directly by the HIV virus, by certain cancers and opportunistic infections that result from a weakened immune system, or by the toxic effects of medications used to treat infection. Other neurological complications may be influenced by, but are not directly caused by, the HIV virus.

HIV-associated neurocognitive disorders (HAND) include a spectrum from no symptoms to severe neurocognitive impairment. The more serious forms of HAND also are referred to as AIDS dementia complex (ADC) or HIV-associated dementia and primarily occur in people with more advanced HIV infection. Signs and symptoms include encephalitis (inflammation of the brain), behavioral changes, and a gradual decline in cognitive function, including trouble with concentration, memory, and attention. People with ADC also show progressive slowing of motor function and loss of dexterity and coordination. When left untreated, ADC can be fatal.

People with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), are at special risk for oral health problems. Some of the most common oral problems for people with HIV/AIDS are: chronic dry mouth, gingivitis, bone loss around the teeth (periodontitis), canker sores, oral warts, fever blisters, oral candidiasis (thrush), hairy leukoplakia (which causes a rough, white patch on the tongue), and dental caries. Combination antiretroviral therapy, which is used to treat the HIV condition and restore immune system function, has made some oral problems less common. Oral conditions can be painful, annoying, and can lead to other problems.

Causes

People with HIV/AIDS have an increased risk for oral health problems because HIV/AIDS weakens the immune system and makes it harder to fight off infection.

Symptoms

Oral health problems may include:

Treatment

The most common oral problems linked with HIV can be treated. So talk with your doctor or dentist about what treatment might work for you.

Helpful Tips

In addition to the problems listed in the table above, you may experience dry mouth. Dry mouth happens when you don’t have enough saliva, or spit, to keep your mouth wet. Saliva helps you chew and digest food, protects teeth from decay, and prevents infections by controlling bacteria and fungi in the mouth. Without enough saliva, you could develop tooth decay or other infections and might have trouble chewing and swallowing. Your mouth might also feel sticky or dry and have a burning feeling, and you may have cracked, chapped lips.

To help with a dry mouth, try these things:

• Sip water or sugarless drinks often
• Chew sugarless gum or suck on sugarless hard candy
• Avoid tobacco
• Avoid alcohol
• Avoid salty foods
• Use a humidifier at night

Talk to your doctor or dentist about prescribing artificial saliva, which may help keep your mouth moist.

What is osteoporosis?

Osteoporosis is a disease that develops due to bone loss. The bones of people with osteoporosis become weak and are more likely to break. Osteoporosis increases the risk of broken bones of the hip, spine, and wrist.

The risk of osteoporosis increases as people age. Anyone can get osteoporosis, but it’s most common in older women.

HIV infection and some HIV medicines may increase the risk of osteoporosis in people with HIV.

What are the risk factors for osteoporosis?

There are many risk factors for osteoporosis. Some risk factors can’t be changed, while other risk factors can be managed with lifestyle choices.

Risk factors for osteoporosis that can’t be changed include:

• Age: The risk of osteoporosis increases as people get older.
• Gender: Compared to men, women have smaller bones and lose bone faster due to hormonal changes after menopause.
• Race/ethnicity: The risk of osteoporosis is greatest for white and Asian women.
• Family history: Osteoporosis tends to run in families.

The following risk factors for osteoporosis can be controlled by lifestyle choices:

• Poor diet: A diet low in calcium and vitamin D increases the risk of osteoporosis.
• Physical inactivity: Physical inactivity tends to weaken bones.
• Smoking: Smoking increases the risk of osteoporosis.
• Alcohol: Too much alcohol can cause bone loss and broken bones.

What are the symptoms of osteoporosis?

Bone loss that leads to osteoporosis occurs without symptoms. The first sign of osteoporosis is often a broken bone.

A bone mineral density test is used to measure bone health. The test, which is painless, is used to diagnose osteoporosis.

People with HIV may wish to discuss bone mineral density testing with their health care providers.

What steps can a person take to prevent osteoporosis?

People can take the following steps to prevent osteoporosis.

• Eat a healthy diet rich in calcium and vitamin D. Foods high in calcium include milk and other dairy products, broccoli, sardines, tofu, and almonds. Milk is fortified with vitamin D. Egg yolks, saltwater fish, and liver are also high in vitamin D. People can also take calcium and vitamin D supplements.
• Stay active. Physical activities, such as walking and lifting weights, can make bones stronger and help slow down bone loss.
• Do not smoke.
• Cut down on alcohol. If you drink alcohol, drink in moderation.

How is osteoporosis treated?

Treatment for osteoporosis includes eating a healthy diet rich in calcium and vitamin D and getting regular exercise to improve bone health. There are also medicines to help prevent and treat osteoporosis.

People with osteoporosis also need to avoid falls that can lead to broken bones. For example, they may use a cane or walker to help prevent falls.

Why do people with HIV develop a rash?

A rash is an irritated area of the skin that is sometimes itchy, red, and painful. Possible causes of a rash in people with HIV include:

• Acute HIV infection
• Other infections
• HIV medicines
• Other medicines

Acute HIV infection
Acute HIV infection is the earliest stage of HIV infection. Symptoms of acute HIV infection may include a rash.

Other infections
Without treatment, HIV gradually destroys the immune system. Damage to the immune system puts people with HIV at risk of infections, and a rash is a symptom of many infections.

Medicines
Many medicines, including some HIV medicines, can cause a rash.

A rash due to an HIV medicine is often not serious and goes away in several days to weeks without treatment. But sometimes when an HIV medicine is causing a rash, it may be necessary to switch to another HIV medicine.

If you are taking HIV medicines, tell your health care provider if you have a rash. In rare cases, a rash caused by an HIV medicine can be a sign of a serious, life-threatening condition.

What are serious rash-related conditions?

A rash can be a sign of a hypersensitivity reaction. A hypersensitivity reaction is a potentially serious allergic reaction to a medicine. In addition to a rash, signs of a hypersensitivity reaction can include difficulty breathing, dizziness, or lightheadedness. A severe hypersensitivity reaction can be life-threatening and requires immediate medical attention.

Stevens-Johnson syndrome (SJS) is a rare but life-threatening hypersensitivity reaction reported with the use of some HIV medicines. People taking HIV medicines need to know about this condition. It rarely occurs, but when it does, it can cause death.

Symptoms of SJS include fever, flu-like symptoms, rash, and painful blisters that may spread throughout the body.

If you have symptoms of SJS, get medical help immediately. SJS can be life-threatening.