Side Effects of Truvada, Other NRTI Drugs Used To Treat HIV Could Cause Glaucoma: Study

NRTI drug users face twice the risk of a glaucoma diagnosis when compared with those who are not taking the medication, researchers warn.

The findings of a new study raise concerns that some antiviral medications used to treat HIV could increase the risk of an eye disease known as primary open-angle glaucoma (POAG), which can lead to blindness.

Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) are a widely used class of medications, which included Truvada, Ziagen, Viread and other HIV drugs that attempt to block the virus from creating the DNA it needs to replicate itself.

As a retrovirus, HIV uses a process known as reverse transcription to turn its RNA into DNA, which it then inserts into the host human’s cells, tricking the cell into making copies of the virus. These drugs interfere with the enzyme HIV needs to make the process work.

However, according to a study published in the medical journal Ophthalmology late last month, those same drugs appear to also be linked to an increased risk of POAG, which is the most common form of glaucoma. The condition causes a build-up of fluid pressure in the eye which can damage the optic nerve, causing vision problems, including blurred vision and even blindness.

The researchs conducted a cohort study involving more than 300,000 individuals who were 40 years or older, and participating in the National Institutes of Health “All of Us” dataset, looking at factors such as age, race, sex at birth, HIV diagnosis, hepatitis B diagnosis and their family history of POAG.

Led by Dr. Joan M. O’Brien of the Penn Medicine Center for Genetics of Complex Disease, the team of researchers found that users of NRTI drugs like Truvada were more than twice as likely to develop glaucoma when compared to those who did not take the drugs. When matched with subjects of similar age, gender and other factors, NRTI users appeared to have a 4.32% chance of developing POAG, compared to only a 2% chance among non-users.

Researchers accounted for multiple factors that could influence the findings, but NRTI use consistently remained associated with a two-fold increased risk of POAG. Even after adjusting for the likelihood that Truvada users may undergo more frequent eye exams, the elevated risk persisted.

“Our study shows that NRTI exposure is associated with higher incidence of POAG. Future prospective studies of individuals at risk of POAG can stratify by NRTI exposure to contribute evidence to the question of causation.”

-Dr. Joan M. O’Brien, Association between nucleoside and nucleotide reverse transcriptase inhibitor use and primary open-angle glaucoma risk in All of Us, June 2025

However, researchers acknowledged the possibility that the increased glaucoma risk may be tied to the severity of HIV itself, rather than the NRTI drugs. While Truvada is also used by HIV-negative individuals as a preventive measure, the study included too few of these users to rule out a drug-specific effect. Still, the researchers noted that patients on NRTIs should, in theory, be less affected by the virus, not more.

Gilead HIV Drug Lawsuits

The HIV drugs market has been dominated for years by Gilead, the original manufacturer of Truvada, Viread, Descovy and other antiviral medications used to treat the disease. The manufacturer has faced tens of thousands of lawsuits over Truvada and other HIV drugs throughout federal and state court systems for years.

Complaints filed by former users of the HIV drugs, who suffered bone fractures and kidney problems, allege that Gilead delayed development of a safer formulation for its medications, involving the compound tenofovir alafenamide fumarate (TAF), used in Descovy. Plaintiffs say Gilead sat on the safer TAF-based HIV drugs until the existing patent on older tenofovir disoproxil fumarate (TDF)-based medications neared its end, in order to maximize profits and avoid generic competition.

In June 2024, Gilead announced it had reached a $40 million Truvada settlement to resolve more than 2,600 such claims in federal courts nationwide. However, it still continues to face tens of thousands of claims pending in California state court, which are expected to go before juries if the drug manufacturer fails to reach a settlement to resolve those claims as well.

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