Side effects

Nausea and vomiting
Feeling tired
Hyperglycemia and diabetes
Increased bilirubin

Approximately 80% of all pregnant women using combination therapy will experience some sort of side effects. This is similar to the percentage of people using HIV treatment who are not pregnant.

Most side effects are minor and include nausea, headache, feeling tired and diarrhoea. Sometimes, but more rarely, they can be very serious.

i-Base has produced a 36-page guide, Avoiding and Managing Side Effects, which can be very helpful for anyone using HIV treatment. The sections in this booklet about getting on with your doctor can also be helpful whether or not you are on treatment.

One big advantage of being pregnant is the thorough monitoring at regular clinic visits. This will make it easier to discuss any side effects with your doctor.

Some side effects of HIV medicines are very similar to the changes in your body during pregnancy, such as morning sickness. This can make it harder to tell whether treatment or pregnancy is the cause.

Nausea and vomiting

Many HIV medicines can cause nausea and vomiting. This is more common when you first begin taking them.
If you are pregnant, though, such side effects can present extra problems with morning sickness and adherence.
There's more on nausea and vomiting in the i-Base side effects guide.
Tips to reduce nausea and help with adherence.

Feeling tired

You may feel more tired than usual. Again, this is to be expected, especially if you are starting HIV treatment and pregnant at the same time.
Anaemia (low red blood cells) can cause tiredness. It is a very common side effect of both AZT and pregnancy. A simple blood test checks for this.
If you have anaemia you may need to take iron supplements.
There's more on feeling tired in the i-Base side effects guide.

Hyperglycemia and diabetes

All pregnant women are at risk of developing hyperglycemia and diabetes during pregnancy. Women taking protease inhibitors in pregnancy can have a higher risk of this common complication.
You should be sure to have your glucose levels closely monitored and be screened for diabetes during pregnancy. This is routine for all pregnant women.
There's more on protease inhibitors and increased glucose in the i-Base side effects guide.

Increased bilirubin

Outside of pregnancy, protease inhibitors have been associated with increased levels of bilirubin. This is a measure of the health of your liver. This is a side effect of the protease inhibitor atazanavir.
There is not yet very much experience of using this drug in pregnancy but so far it seems to be fairly safe.
Your healthcare team will follow you and your baby's bilirubin levels very carefully. This is because extremely high levels of neonatal bilirubin levels may damage a baby's developing brain.
A recent report from the UK of 33 pregnancies of mothers using atazanavir showed no seriously high bilirubin levels in mothers or in their babies.
There's more on increased bilirubin in the i-Base side effects guide.

Lactic acidosis

Pregnancy may be an additional risk factor for raised levels of lactic acid. Your liver normally regulates this.
Lactic acidosis is a rare but dangerous and potentially fatal side effect of nucleoside analogues.
Using d4T and ddI together in pregnancy appears to be particularly risky for lactic acidosis. This combination is not recommended in pregnancy.
There's more on lactic acidosis in the i-Base side effects guide.