When it comes to side effects of HIV medications, the gut (gastrointestinal tract) is one of the most commonly affected areas in the body. Nausea, vomiting, and diarrhea are three ways in which the gut keeps toxins like bacteria, viruses, and even medications out of the body.
These side effects don’t occur in everyone, and fortunately when they occur as side effects of HIV treatment, they are usually mild and tend to diminish after the first few days or weeks of starting treatment. Even so, they can seriously impact your quality of life, and they need to be addressed as a part of your overall health so you can get the most out of your treatment.
However, if nausea, diarrhea, and vomiting are severe or ongoing, they can prevent HIV meds from entering the bloodstream and doing what they need to do. Report these symptoms to your doctor to determine if they are a side effect or a symptom of something more serious.
Nausea and Vomiting
Two of the most common gut-related side effects of HIV treatment are nausea and vomiting. Most people living with HIV who experience these usually do so after starting a new regimen. In most cases, these side effects eventually lessen or go away completely after the first few days or weeks of treatment.
If nausea is seriously affecting your quality of life, including your ability to eat, or if your vomiting continues for more than a few days, contact your doctor. Even though nausea and vomiting can be common, they are not a normal part of living with HIV. Consider these options with your doctor:
- Switch treatments. It may be a little bit of trial and error to figure out which drug(s) is causing the nausea or vomiting and switching may even cause more side effects. Further, switching to another drug might not be possible for those with a limited number of drugs to choose from, as in the case of drug resistance.
- Prescription medicines. A class of drugs called antiemetics work by blocking receptors in the brain’s center that controls vomiting. Although antiemetics can make people feel drowsy or mildly sedated, they can help with vomiting. Some of the most common antiemetics include Zofran (ondansetron), Kytril (granisetron), Anzemet (dolasetron) and Decadron (dexamethasone). Another option is Marinol (dronabinol) —a synthetic version of THC, the active ingredient in marijuana. Not all drugs are equally effective for everyone, and they sometimes work best when used in various combinations. These drugs work best if they are taken 30 to 45 minutes before taking any HIV meds. Some antiemetics, particularly Reglan (metoclopramide), can be dangerous if taken at the same time as certain protease inhibitors, including Norvir (ritonovir) and Kaletra (lopinavir/ritonavir).
- Cannabis can help improve nausea and appetite loss, and two chemicals in cannabis may help: THC (tetrahydrocannabinol) and CBD (cannabidiol). It is important to note that smoking any substance is dangerous to the lungs. Another option is to add cannabis to food, which may be a safer way to experience its medicinal effects. Many cannabis dispensaries usually have an array of products to choose from, and most states have legalized cannabis for medicinal use and several have legalized it for recreational use.
Other tips to ease nausea:
- Eat smaller meals more often.
- Cut a lemon and smell the fresh scent.
- Drink or eat foods with ginger in them, like ginger ale or ginger tea.
- Bland foods with fewer spices and herbs are easier to digest. Stick to foods low in fat but high in starches and carbohydrates.
- Relax before meals, chew slowly and don’t rush your meal. Keep from over-eating.
- Breathe deeply and slowly when you first feel nauseated.
- Acupressure bands (known as Sea-Bands) placed on the forearm about two inches up from the wrist may help.
Diarrhea—loose, watery stools—is often a short-term side effect of HIV medications and usually improves after a few days or weeks of treatment. Diarrhea is also a symptom of many infections and conditions that occur in people living with HIV, so it is important that you report it to your doctor.
Generally speaking, diarrhea that occurs five times or more a day, for five or more consecutive days, and results in five pounds or more of weight loss, should always be reported and managed to prevent dehydration. You may want to report even less severe symptoms to your doctor to be on the safe side.
Diarrhea can also be a long-term problem for people taking certain HIV drugs. While this diarrhea doesn’t usually lead to dehydration or other life-threatening problems, it can be a nuisance and may profoundly affect a person’s quality of life.
Here are a few tips for managing diarrhea:
Adjust your diet. Some foods can cause or worsen diarrhea, while others can help to relieve it.
- The BRATT diet—Bananas, Rice (white), Apple juice or sauce, Toast and Tea (herbal)—may help control diarrhea.
- Foods high in fiber or high in starch are recommended.
- Clear juices (apple, pear or cranberry) are less harsh than those high in acid (orange, grapefruit or pineapple).
- Eat small amounts of food throughout the day, instead of larger meals.
- Add nutmeg to foods to slow down the movement of material through the intestines.
- Avoid foods that can make diarrhea worse, such as coffee or other beverages with caffeine, alcohol, chocolate, fried and fatty foods, spicy foods, fat substitutes, dairy products, highly processed foods and foods high in soluble fiber, such as raw vegetables, potato peels, beans and brown rice.
Increase your fluids. Try to drink at least three quarts of fluid per day, unless your doctor tells you not to do so. This will help to prevent dehydration and malnutrition. Drinking clear juices and sports drinks at room temperature is recommended.
Use over-the-counter and prescription drugs. There are several over-the-counter (OTC) drugs available, including Imodium AD, Kaopectate and Metamucil. Metamucil is commonly used as a laxative, but its fiber contents can also absorb water in the colon and help control diarrhea. Some of the anti-diarrheal drugs available by prescription include Mytesi (crofelemer), Lomotil (diphenoxylate), pancrelipase (a pancreatic enzyme sold under many brand names) and tincture of opium. As with drugs used to control nausea and vomiting, anti-diarrhea drugs work best if taken 30 to 45 minutes before taking the medication causing the diarrhea.
Try complementary therapies. Peppermint and ginger may calm the gut and are often used to control diarrhea. Others include the probiotic Lactobacillus acidophilus (available in capsules and yogurt), glutamine and the Chinese herbal blend Quiet Digestion.
Last Reviewed: February 2, 2022