Hesperian Health Guides

Side effects while taking ART

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HealthWiki > Helping Children Live with HIV > Chapter 11: ART: Medicines for HIV > Side effects while taking ART

While ART makes most children healthier within a few weeks, some children on ART have side effects, which are problems a medicine might cause even as it helps. Not all children have side effects with ART.

Most side effects from ART can be uncomfortable but are not serious. However, a few side effects are serious.

Dangerous side effects that ART might cause

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These side effects are rare, but if your child has any of the problems listed here while taking ART, get medical help quickly, and bring the medicine with you:

  • Difficulty breathing. Do not give more medicine if your child has trouble breathing after taking a medicine.
  • Severe pain in the abdomen (tummy or belly).
  • Severe rash with blistering skin.
  • Yellow eyes (jaundice), sometimes with nausea or loss of appetite.
  • Sudden weight loss.
  • Seizures—sudden short periods of unconsciousness or changes in mental state, often with shaking movements.

Common ART side effects

Most side effects of ART are not dangerous. They may be different in different people, and it may take some time to learn what helps. Most go away on their own after a few weeks as the child’s body gets used to the medicine. If they are more severe or do not go away, or if you know something is not right with your child, seek help at the HIV clinic. Do not stop giving the child ART without getting medical advice.

Be patient with your child while she gets used to taking ART and its side effects. This may be difficult if you are also taking ART and have your own side effects. Support from family, friends, and others taking ART can help you both get through the rough times and stay on your medicines.

Help your child be more comfortable — see the different problems and what to do on the next few pages. (Many of these tips may also help adults who take ART.) Chapter 12 and Chapter 13 also have information about how to help your child when she is not feeling well.

Sleepy Lizzie and her ART

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When my daughter Lizzie started her ART she was always so tired and sleepy. I did not think we would get through it.
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Wake up Lizzie. Time for your medicine.
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But my sister helped me. For 5 weeks she came to my door almost every morning to help.
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Remember, the nurse said the sleepy feeling will go away soon.
She sang to Lizzie and helped her take her medicines.
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Now, 4 months later, my daughter has gained weight and has so much energy — she plays and will go to school next term.
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I told you it would get better!.
And she feels so close to her aunt.

Feeling very tired

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Allow your child to rest. It may help her sleep well if you wake her and put her to bed at the same times each day. During the day, take her outside and encourage her to play — having fun and moving around will help her sleep well when it is time. Make sure she is getting enough to eat.

Being very tired is sometimes a sign of anemia, also called weak blood. Discuss this problem with a health worker, since some ART can cause anemia.

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To help with anemia, give more foods with iron, such as dark leafy greens, eggs, beans, fish, chicken, and meat.

Get medical help if your child’s feet are swollen, if she is too tired to eat or move much, or if she becomes weaker and cannot do things she could do before.


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Help your child rest quietly and away from bright light and noise. Cover his eyes with a cool, damp cloth. Make sure the child has enough to eat and drink. Lack of food or water can cause headache.

Give your child paracetamol (acetaminophen). Avoid coffee, fizzy drinks, and tea with caffeine.

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Gently rub your child’s neck and the sides of his forehead with your thumbs. Older children can do this for themselves.

Get medical help if headaches happen often or are very painful, or if:

  • the child’s neck is stiff.
  • the child has trouble seeing or says things look strange.
  • paracetamol does not help.
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Give the child plenty of clean water, herbal tea, or rehydration drink to replace the fluids she is losing. If you are breastfeeding, breastfeed her more often. Give a few spoonfuls of food every 2 hours — bananas, rice, and soda crackers can help with diarrhea. Avoid spicy or greasy foods and animal milk. Peel fruits and vegetables to avoid germs that could make her diarrhea worse.

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Get medical help if your child has:

  • more than 4 watery or soft bowel movements in a day.
  • diarrhea that lasts more than 2 or 3 days.
  • blood in her stool.
  • a fever that lasts a day or more.
  • thirst, but will not drink.


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Help your child rest in a cool place. Put damp cloths on his forehead, arms, and legs, or bathe him in cool (not cold) water. Give him paracetamol and clean water to drink. See more ways to lower fevers.

Get medical help quickly:

  • if the fever happens within a few days of your child starting ART or a new type of ART.
  • if the fever goes very high (over 39°C or 102°F).
  • if your child has convulsions.
  • if your child has fever, nausea, or vomiting for more than 24 hours.

Nausea, vomiting, and no interest in food

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Give your child ART just after breastfeeding or with food (check to see if you should avoid certain foods). Give small meals of plain foods (rice, porridge) more often, and avoid greasy or spicy foods. If he is vomiting, give sips of porridge or rehydration drink every few minutes until vomiting stops.

Try to prevent your child from losing weight. Give more of the foods he can keep down, to maintain his strength. Seek help if he is losing weight. See more on helping children with nausea and vomiting.

Get medical help if:

  • your child has sharp belly pains.
  • vomiting lasts more than a day or has blood in it.
  • he is thirsty but does not drink or eat.
  • he also has a fever for more than 24 hours.

Dry mouth

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Rinse your child’s mouth with clean water and a pinch of salt. Give clean water and juices to sip often. Avoid sweets, cool drinks, and coffee. Get medical help if:

  • your child’s tongue or mouth is swollen.
  • he has white or red spots on his tongue or in his mouth, which could be signs of thrush.

Skin rash

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Keep the child’s skin clean and dry. Wash with unscented soap and water. Avoid very hot baths or showers. Use calamine lotion to calm itching. Keep the child out of the sun.

Get medical help if the child also has a general ill feeling, fever, muscle or joint aches, blisters or mouth sores, redness inside the eyelids, swelling of the face, or tiredness.

Seek medical help quickly if the rash spreads rapidly and is red or purple, or peeling or blistering — this is an emergency! Stop giving the child ART and see a health worker.

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Dizziness or feeling “light-headed”

Help your child sit or lie down until the dizziness goes away. Give her plenty of water. Do not ask the child to lift anything heavy or move quickly until the dizziness goes away. If your child takes her ART once a day in the morning, ask your health worker if she can take the medicine just before going to sleep when the dizziness will bother her less.

Get medical help if dizziness lasts more than 3 days.

Strange or bad dreams, hallucinations (seeing things that are not there)

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Help your child feel calm before going to sleep by rubbing his back, singing to him, telling a story, or remembering a nice thing that happened that day. Warm milk or water at bedtime may help. Do not allow him to watch television just before bedtime, and avoid tea or fizzy drinks in the evening, which can make a child wakeful. Let him sleep near you or near an older child if he is afraid.

Get medical help if your child cannot sleep at all for 3 nights or more.

Feeling very sad or worried

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Talk with your child about his feelings and encourage him to talk with others. Encourage questions and try to answer them fully. Help older children by asking them how they feel, sharing good memories, including of people who have died, or discussing what they are worried about.

Get medical help if your child is so sad or worried he gets no rest from these feelings, or if he becomes violent or very scared and cannot be helped or comforted, or if he talks about harming himself.

Your child’s mind wanders or does not seem to work well

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Sometimes a child on ART seems lost in his own world, very forgetful, or understands things less than other children. Be patient, and help him be patient with himself. Reassure him he will feel better soon, when his body gets used to the medicine. Remind him about tasks or chores without scolding him. Allow extra time for activities.

Get medical help if he becomes very confused or disoriented.

This page was updated:27 Nov 2019