Nausea/Vomiting

Robin McKenzie, M.D.
Nausea/Vomiting is a topic covered in the Johns Hopkins HIV Guide.

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CLINICAL

  • Can be caused by medications: antiretrovirals (esp. RTV, other PIs, AZT), high-dose TMP-SMX, macrolides, opiates
  • Most antiretrovirals may cause some nausea.
    • For most except PIs the rate of nausea is low.
    • To improve adherence discuss potential adverse effects before starting ARVs.
    • Nausea greatest in first 1-2 wks of treatment[11].
    • Inform pts that GI Sxs often improve. Offer PRN anti-emetic if needed.
  • Nausea/vomiting may be a sign of a life-threatening reaction to ART: ABC hypersensitivity (Only prescribe ABC if HLA B*5701 is negative.); NVP hepatotoxicity (Do not prescribe NVP for women with CD4 >250 or men with CD4 >400); lactic acidosis with older, non-recommended NRTIs (d4T, ddI, AZT).
  • Metabolic causes: adrenal insufficiency, uremia, hypercalcemia
  • CNS disease: mass lesions, meningitis
  • Hepatitis: Flares of HBV may occur if 3TC, FTC, TDF, or TAF are stopped abruptly.
  • GI disease: gastritis, gastroparesis, reflux esophagitis, PUD, lymphoma, KS, hepatobiliary disease (including drug-induced hepatitis), pancreatitis
  • Misc: opiate withdrawal, pregnancy, cannabinoid hyperemesis syndrome

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CLINICAL

  • Can be caused by medications: antiretrovirals (esp. RTV, other PIs, AZT), high-dose TMP-SMX, macrolides, opiates
  • Most antiretrovirals may cause some nausea.
    • For most except PIs the rate of nausea is low.
    • To improve adherence discuss potential adverse effects before starting ARVs.
    • Nausea greatest in first 1-2 wks of treatment[11].
    • Inform pts that GI Sxs often improve. Offer PRN anti-emetic if needed.
  • Nausea/vomiting may be a sign of a life-threatening reaction to ART: ABC hypersensitivity (Only prescribe ABC if HLA B*5701 is negative.); NVP hepatotoxicity (Do not prescribe NVP for women with CD4 >250 or men with CD4 >400); lactic acidosis with older, non-recommended NRTIs (d4T, ddI, AZT).
  • Metabolic causes: adrenal insufficiency, uremia, hypercalcemia
  • CNS disease: mass lesions, meningitis
  • Hepatitis: Flares of HBV may occur if 3TC, FTC, TDF, or TAF are stopped abruptly.
  • GI disease: gastritis, gastroparesis, reflux esophagitis, PUD, lymphoma, KS, hepatobiliary disease (including drug-induced hepatitis), pancreatitis
  • Misc: opiate withdrawal, pregnancy, cannabinoid hyperemesis syndrome

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Last updated: November 9, 2022