||Principally ZDV and PIs (such as LPV/r, RTV) but can occur with all ARVs
Nausea, emesis—may be associated with anorexia and/or abdominal pain
|Varies with ARV agent. 10%–30% in some series.
||Instruct patient to take PIs with food.
Generally improves with time; monitor for weight loss, ARV adherence.
|Reassure patient/caretaker that nausea and vomiting will likely decrease over time.
Provide supportive care including instruction on dietary modification.
Although antiemetics are not generally indicated, they may be useful in extreme or persistent cases.
||PIs (NFV, LPV/r, FPV/r), buffered ddI
Generally soft, more frequent stools
|Varies with ARV agent.
10%–30% in some series.
||Generally improves with time (usually over 6-8 weeks); monitor for weight loss, dehydration.
||Exclude infectious causes of diarrhea.
Although data in children on treatment for ARV-associated diarrhea are lacking, dietary modification, use of calcium carbonate, bulk-forming agents (psyllium), or antimotility agents (loperamide) may be helpful.
||ddI (especially with concurrent d4T or TDF); reported,
albeit rarely, with most ARVs
Any time, usually after months on therapy
Emesis, abdominal pain, elevated amylase and lipase (asymptomatic hyperamylasemia or elevated lipase do not in and of themselves indicate pancreatitis)
|<1%–2% in recent series. Frequency was higher in the past with higher dosing of ddI.
||Concomitant treatment with other medications associated with pancreatitis (such as TMP-SMX, pentamidine, ribavirin)
|Avoid use of ddI in patients with history of pancreatitis.
||Discontinue offending agent.
Manage symptoms of acute episode.
If associated with hypertrigly-ceridemia, consider interventions to lower TG levels.