Dr. Boyle,

Which potent HAART regimens are least likely to cause nausea and vomiting as side effects? I know there can be variation among people, but are there some combinations of drugs that are effective in suppressing viral load, but kinder with regard to these symptoms? Is there a trade off in that they cause other worse symptoms?

Thanks.

The antiretrovirals least likely to cause problems with nausea and vomiting include efavirenz regimens that include lamivudine (3TC) or emtricitabine (FTC) with either stavudine (d4T) or tenofovir. The protease inhibitors (except perhaps atazanavir) and zidovudine (AZT) are probably the worst about causing nausea and vomiting, although many patients who are even on these regimens generally experience this problem early on in therapy and experience significant improvement over time, especially if they are given a medication to control it.