Clinical Guide > Common Complaints > Nausea and Vomiting

Nausea and Vomiting

January 2011

Chapter Contents


Nausea with or without vomiting, and occasionally vomiting without nausea, can occur at any stage of HIV infection. Nausea is a common adverse effect of many antiretroviral (ARV) and other medications, and it often occurs within weeks of starting new medications. In some cases, nausea causes significant discomfort and may interfere with medication adherence. Nausea and vomiting also may be symptoms of a serious complication of ARV therapy, or signs of an opportunistic infection or neoplasm in patients with late-stage AIDS. Clinicians must identify the cause of nausea and vomiting and initiate appropriate treatment.

S: Subjective

The patient experiences nausea with or without vomiting, or vomiting without nausea.

Ascertain the following during the history:

O: Objective

Check vital signs, including orthostatic blood pressure and heart rate measurements.

Conduct a thorough physical examination, including evaluation of the following:

Review recent CD4 measurements, if available, to determine the patient's risk of opportunistic illnesses.

A: Assessment

A partial differential diagnosis includes the following conditions:

P: Plan

Diagnostic Evaluation

Perform laboratory work and other diagnostic studies as suggested by the history, physical examination, and differential diagnosis. Tests may include the following:


Once the diagnosis is made, appropriate treatment should be initiated. In seriously ill patients, presumptive treatment may be started while diagnostic test results are pending. See appropriate chapters in section Comorbidities, Coinfections, and Complications and relevant guidelines.

In the case of significant adverse effects from ARVs or other medications, substitute a less emetogenic ARV for the problematic medication, if possible (without compromising the efficacy of the treatment regimen). In the case of serious or life-threatening medication toxicities (e.g., lactic acidosis or abacavir hypersensitivity reaction), discontinue the problematic medication (see chapter Adverse Reactions to HIV Medications).

After the workup and exclusion of life-threatening illness, symptomatic treatment can be considered. If nausea and vomiting are attributable to medications that are vital to the patient, and these complications are not life-threatening, antiemetic therapy may be the best treatment. Chronic therapy is not always necessary. Some patients obtain adequate relief by breaking the "nausea cycle" with effective antiemetics for 1-2 days and then establishing meals or snacks with medications. Patients with dehydration may require administration of fluids (PO or IV) to relieve nausea. For patients with chronic nausea resulting in weight loss, refer to a nutritionist for assessment and nutritional support.

Symptomatic treatment

Consider the following strategies for symptomatic treatment:

Patient Education