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Managing Symptoms and Side Effects

By Amanda Bell-Kirson, MS, RD, LD

November 1998

This month's column was written by Amanda Bell-Kirson, MS, RD, LD. Amanda is the Clinical Nutrition Therapist at APP Specialty Pharmacy located in Atlanta, Georgia.

Metabolic Disorders | Nausea | Diarrhea | Dry Mouth | Taste Changes | Mouth Sores | Gas | Peripheral Neuropathy | Elevated Liver Function Tests

"Protease Paunch" / Insulin Resistance

This is something that we are seeing more of with all the protease inhibitors. The symptoms include: a belly larger in appearance, decreased muscle mass in arms and legs, increased triglycerides, cholesterol, liver enzymes and blood sugar. The larger belly appearance is due to fat deposits. Stress on the liver and toxicity of the protease inhibitors seem to be the cause of increased triglycerides, cholesterol, liver enzymes and blood sugar. These are all symptoms in decreases insulin sensitivity. Protease inhibitors lower testosterone, and low testosterone is known to correlate with increased insulin resistance in men. In women, insulin resistance increases with elevated testosterone. HIV+ women with low testosterone is associated with low body cell mass, and increased fat mass.


Nausea and Vomiting

If nausea and/or vomiting is a result from either a medication, a treatment or therapy, and infection or other, it is important to find out what the cause is and call your physician if it goes on longer than a day. In determining the cause, do not stop any medications without speaking to your doctor first.



Diarrhea may be caused by many medications and is one of the most common side effects of most anti-viral medications. It also can be caused by infectious organisms, changes in the intestinal lining, food intolerances, allergies, stress, or it can be related to fat distribution (gall bladder) lactose, pancreas/digestive enzymes, roughage and others. Diarrhea can cause dehydration and electrolyte imbalances and for a longer duration malabsorption and malnutrition can occur. Remember to let your doctor know if diarrhea persists for more than a few days.

Food and fluid recommendations:

Medical management:

Nutritional supplements and herbs:

Dry Mouth

Dry mouth can occur with a number of medications, or it can be from HIV itself. Allergies can cause it, and dry mouth occurs with some infections, too. Decreased saliva can make chewing and swallowing difficult; it is also a problem because in the mouth digestion starts and saliva contains digestive enzymes. Without saliva, you can get food build-up which promotes decay and also thrush. Decreased saliva also effects the taste of food. Each time you eat you produce food acids, with normal salivary flow it returns to normal pH within two hours; this environment in your mouth can cause various oral health problems.


Taste Changes

Taste changes can occur from many medications or again candida (thrush) or other infections or possible nutritional deficiencies.


Mouth Sores

Have sores checked out by medical provider to try and find out what is causing them. Whether from candida, bacteria, herpes or other types of infection, or certain medications such as AZT or ddI, apthous ulcers can become severe in the mouth and lower down in the esophagus.

Possible medical treatments or medications:

Food recommendations:

Gas and Bloating


Peripheral Neuropathy

Peripheral Neuropathy can be caused by many medications such as: ddI, ddC, D4T, Vincristine, INH, Dapsone and others. It can also occur with nutritional deficiencies and overdoses, with diabetes and miscellaneous conditions. Peripheral neuropathies can vary from slight tingling and numbness to extreme discomfort, and this is why the treatments also vary.

Nutritional supplements associated with peripheral neuropathies:

Medical management of peripheral neuropathies:


Elevated Liver Function Tests

Medical treatments:

This article was provided by AIDS Survival Project. It is a part of the publication Survival News. You can find this article online by typing this address into your Web browser:

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