May cause fat redistribution (e.g. buffalo hump, peripheral wasting with increased abdominal girth, cushingoid appearance). Often associated with hematologic toxicity including granulocytopenia, severe anemia requiring transfusions, or (rarely) pancytopenia (use with caution in bone marrow compromise). Patients may develop immune reconstitution syndrome resulting in inflammatory response to indolent or residual opportunistic infection. Lactic acidosis and severe hepatomegaly with steatosis reported with nucleoside analogs, including fatal cases (use with caution in risk factors for liver disease). Prolonged use associated with symptomatic myopathy and myositis. Use with caution in severe renal impairment, and in combination with interferon alpha with or without ribavirin in HIV/HBV coinfected patients.