Nausea/Vomiting is a topic covered in the Johns Hopkins HIV Guide.

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  • Often caused by medications: antiretrovirals (esp. RTV, other PIs, AZT), high-dose TMP-SMX, macrolides, opiates.
  • Prevention or treatment of nausea important to improve adherence to therapy.
  • Initiation of ART: nausea greatest in 1st 1-2 wks of ART. Consider prn antiemetic when starting some regimens.
  • Nausea/vomiting may be a sign of a life-threatening reaction to ART: ABC hypersensitivity; NVP hepatotoxicity; lactic acidosis (d4T, ddI, AZT); pancreatitis w/ ddI, especially if combined with d4T (contraindicated), ribavirin (contraindicated) or TDF (reduce dose of ddI).
  • Metabolic causes: adrenal insufficiency, uremia, hypercalcemia
  • CNS disease: mass lesions, meningitis
  • GI disease: gastritis, gastroparesis, reflux esophagitis, PUD, lymphoma, KS, hepatobiliary disease (including drug-induced hepatitis), pancreatitis
  • Misc: opiate withdrawal, pregnancy

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Last updated: November 9, 2011