Short-Term Side Effects
Nausea, Vomiting, and Loss of Appetite
Nausea is a common side effect of ART. Your nausea may worsen if you eat large meals, very hot or cold dishes, or foods that are greasy, spicy, sweet, or acidic. Instead, try eating smaller, more frequent meals that are bland and at room temperature. Additionally, ginger and peppermint may help calm your stomach troubles, while dry foods like crackers and toast are good options if you’re struggling to keep food down.
Smaller, more frequent meals can also help with poor appetite, and protein drinks can provide supplemental nutrients and calories.
If these dietary changes aren’t enough, ask your provider about prescription or over-the-counter (OTC) medications to help relieve nausea. You should also check whether you are taking your medications correctly, because some require an empty stomach while others need to be taken with food, Alejo says.
Diarrhea
The BRAT diet — bananas, rice, applesauce, and (white) toast — used to be frequently recommended for diarrhea because the foods are soft, bland, and low in insoluble fiber, making them easy on the GI tract. The restrictive diet lacks a lot of vital nutrients, however, so you shouldn’t follow it for more than a couple of days. Other foods you can add to balance the diet include oatmeal, boiled potatoes, and brothy soups.
Stay away from foods that can worsen your diarrhea, including:
- Spicy, fatty, starchy, and acidic foods
- Dairy products
- Raw or undercooked meat, fish, and poultry
- Caffeine and alcohol
- Foods that produce gas, like beans and broccoli
- Foods high in insoluble fiber, like whole grains, brown rice, and the skins of fruits and vegetables
Also make sure to stay hydrated as your body recovers from diarrhea.
Antidiarrheal medication options include OTC drugs like loperamide (Imodium) and the prescription drug crofelemer (Fulyzaq), which is specifically for patients on ART.
“Sometimes, taking a fiber supplement like Metamucil or psyllium husk, usually used for constipation, can help with diarrhea because it’s also a bulking agent,” Alejo says.
Fatigue
Fatigue is both a symptom of HIV and a side effect of HIV medications. Regardless of the cause of your fatigue, try walking; low-intensity exercises like jogging, swimming, or biking; or resistance exercises like weight lifting. But don’t push yourself to the point of breathlessness. Also, stay hydrated, eat well-balanced meals, and follow consistent sleep habits.
Headache
“I used to hear a lot of people complain of headaches with the earlier medications like lamivudine and AZT,” says Alejo, who’s been providing HIV services in Hawai’i for more than 25 years. “But not so much now.”
If you do experience headaches, OTC pain killers like aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve) are generally effective. You can also try massaging the base of your skull, placing a cold washcloth over your forehead and eyes, or resting in a quiet, dark room until the headache passes.
Weight Gain
Weight gain can be either a short-term side effect, as your body adjusts to a new medication, or a long-term side effect. If side effects have been a significant issue, your doctor may recommend trying long-acting, injectable ART, which belongs to a class of drugs called integrase inhibitors and is injected once every two weeks to six months, depending on the specific drug.
“These injectables have been a godsend,” Dr. Chow says, adding that, in his experience, they cause significantly fewer side effects. Clinical trials show that patients are more likely to discontinue daily ART due to side effects than long-acting ART.
But like other integrase inhibitors, the long-acting injectables can cause considerable weight gain, especially in Black people. “I’ve had a couple of my patients gain over 40 pounds,” Chow says. Speak with your provider if you experience weight gain — they may recommend that you try a different long-acting injectable, change your dietary and exercise habits, or use GLP-1 weight loss medications, he says.
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