(Last updated: March 1, 2016; last reviewed: March 1, 2016)
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/
|Nausea/Vomiting||Principally ZDV and PIs (e.g., LPV/r, RTV), but can occur with all ARVs and COBI
||Varies with ARV agent; 10% to 30% in some series
||Unknown||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.
|Diarrhea||PIs (particularly NFV, LPV/r, FPV/r), buffered ddI, INSTI (mild)
||Varies with ARV agent; 10% to 30% in some series||Unknown||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 of ARV-associated diarrhea are lacking, dietary modification, use of calcium carbonate (should not be used with DTG), bulk-forming agents (psyllium), or antimotility agents (loperamide) may be helpful.
While there are few published data on its use, crofelemer is FDA-approved for treatment of ART-associated diarrhea in adults but not in children.
||ddI, d4T (especially concurrently or with TDF), boosted PIs
Reported, albeit rarely, with most ARVs
||<2% in recent series
Frequency was higher in the past with higher dosing of ddI.
|Concomitant treatment with other medications associated with pancreatitis (e.g., TMP-SMX, pentamidine, ribavirin)
Previous episode of pancreatitis
|Avoid use of ddI in patients with a history of pancreatitis.||Discontinue offending agent—avoid reintroduction.
Manage symptoms of acute episode.
If associated with hypertriglyceridemia, consider interventions to lower TG levels.
|Key to Acronyms: ART = antiretroviral therapy; ARV = antiretroviral; COBI = cobicistat; d4T = stavudine; ddI = didanosine; DTG = dolutegravir; FDA = Food and Drug Administration; FPV/r = fosamprenavir/ritonavir; INSTI = integrase strand transfer inhibitor; LPV/r = lopinavir/ritonavir; NFV = nelfinavir; PI = protease inhibitor; RTV = ritonavir; TDF = tenofovir disoproxil fumarate; TG = triglyceride; TMP-SMX = trimethoprim sulfamethoxazole; ZDV = zidovudine|