Side Effects of Medications

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Nausea and Vomiting

All HIV medications have side effects and most of them are related to the gastrointestinal (also called GI) tract. The GI tract is one of the body's first lines of defense and also where medications are turned into their active form. The most common effects are nausea, vomiting, and diarrhea. As the body adjusts to medications, most of the symptoms will improve over time. However, if vomiting is severe and continuous, your child may become dehydrated or suffer from poor nutrition. If these symptoms persist or become frequent, please notify the care team.

When trying to manage nausea, vomiting, and diarrhea, it is important to read the information that the pharmacist gives you with each medication. Often, a small snack with the medications will help with the problems. Some medications need to be taken on an empty stomach to help the body absorb them into the bloodstream so they may begin to fight the HIV. Some other tips to help decrease nausea and vomiting associated with taking medications include:

Eating small frequent meals
Eating bland foods
Breathing deeply and slowly through nausea

Diarrhea

Diarrhea is defined as having loose watery stools more than three times per day. Infants less than one year of age who have diarrhea for more than two days should be reported to the office. Some tips to help manage diarrhea include:

Avoid foods high in fiber such as cereals, raw vegetables, and fruits except bananas.
Provide frequent small meals consisting of bland foods.
Encourage clear liquids such as Pedialyte for infants or Gatorade. Avoid excessive amounts of plain water. Avoid fruit juices, caffeine containing drinks, and milk. Liquids should not be bubbly and should be served close to room temperature and not hot or cold.
Often times, doctors will recommend a BRAT diet during diarrhea which stands for Bananas, Rice, Applesauce, and Toast.

Diarrhea left untreated can cause dehydration and, if left untreated for a very long time, can result in malnutrition. Diarrhea may be caused from lots of different sources including medication side effects, infections, or lactose intolerance (which means the inability to digest milk products). If the diarrhea is a side effect of the medication, it may get better with time. If not and the child cannot tolerate the symptoms, a change in medication may be considered or additional medications may be added to decrease the symptoms.

Fatigue

More than half of the people diagnosed with HIV experience fatigue or extreme tiredness at some point during their disease. This fatigue may be related to the HIV infection itself, especially if it is poorly controlled. Fatigue can also be caused as a side effect of medication, such as a low red blood cell count, or with an associated infection. Some ways to fight fatigue are to eat well-balanced, nutritious meals, regular exercise, and getting adequate rest for about the same number of hours each night. Firm bedtimes in young children and a firm wake-up time in teenagers should be maintained.

Weight Loss and Wasting

Weight loss may result from advanced HIV infection (AIDS), side effects of medications, or from associated infections. Wasting occurs when the body loses some of its muscle because food is not being absorbed well by the body and the body fails to keep the muscles fed. Fat and protein, which make up muscle tissue in the body, get broken down by the body for energy when food is not available or is poorly absorbed. This process leads to wasting.

Other causes of weight loss or wasting include loss of appetite, or vomiting and diarrhea, or from increased energy needs of the body known as increased metabolism. The body will have an increased metabolism or increased energy needs during times of illness such as HIV infection. This may make it difficult to take in enough calories to meet all the body's energy needs. The dietitian is an important member of your health care team and is very important in recognizing early signs of weight loss and heading off problems with wasting. The doctor and dietitian will evaluate your child's nutritional well being with examinations and laboratories when necessary.

Peripheral Neuropathy

Peripheral neuropathy is pain that is felt in the hands, legs, and/or feet. It may be constant or come and go. Some of the HIV medications can cause this to happen. If the HIV disease advances to later stages or AIDS, it can also cause this problem. Symptoms of peripheral neuropathy include numbness, decreased feeling to pain or temperature, extreme sensitivity to touch, tingling or burning sensations, loss of balance and/or coordination, muscle weakness, pain, or cramping. Sometimes, a medication may need to be stopped if the symptoms are severe. Concerns over peripheral neuropathy should be reported to the health care team at each clinic visit.

Immune Reconstitution Syndrome

Often times as a person's immune system begins to recover after the medications begin to work, they will initially feel tired, achy, or in general worse than they did before starting medications. This occurs as the immune system is reconstituted which means that it occurs as the CD4 count rises toward more normal levels. This likely occurs due to the person having the ability to react to certain infections that were in the body that went unnoticed since the immune system was too weak to fight against them previously. Often times, this will require time and patience to resolve but there may be occasions where further evaluation for infections and possible treatment may be necessary. Please alert the health care team if your child experiences any of these problems.

[Keywords:HIV]

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