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For many people with HIV infection, choice of a hospital is limited. Participants in HMOs are required to use specific hospitals. People from small cities or from rural areas often have only one hospital near enough to choose. In medical emergencies, a public ambulance is required to take the patient to the nearest hospital, leaving the family and the patient little say in the matter, unless they hire a private ambulance.

In most instances, the physician responsible for the care of the person with HIV infection will make a recommendation depending on which hospital has the resources necessary for that person, and in which hospital the physician has admitting privileges (meaning the physician is

allowed to admit and treat patients).

A large teaching hospital might best be chosen by a person who has unusual complications that require specialized services. If you have a strong wish to go to a certain hospital, you should tell your physician. In the event that your physician is not on the admitting staff of that hospital, he or she can often transfer your medical care to another physician.

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Nausea and vomiting have a number of causes, the most common being the drugs taken for complications of HIV infection. Drugs whose side effects include nausea and vomiting are: trimethoprim-sulfamethoxazole (Bactrim, Septra), pyrimethamine (Daraprim), ketoconazole (Nizoral), amphotericin B, pentamidine (Pentam), acyclovir (Zovirax), ganciclovir (DHPG), dapsone, and trimethoprim.

Usually the nausea and vomiting are dose-related, meaning that reducing the dose of the drug will reduce the nausea and vomiting. Or the drug can be taken at times that will not interfere with meals. Or, for many conditions, alternative drugs can be prescribed. Consultation with a physician will usually reveal which drug is likely to be the cause, which is expendable, which can be safely reduced in dose, and which can be safely substituted.

Some of the opportunistic infections—particularly infections that affect the head or the digestive system—can also cause nausea and vomiting. People who have nausea and vomiting, who are taking no medication, and who have additional symptoms such as fever or diarrhea should see their physicians.

In general, the person who has nausea or vomiting should eat small, frequent meals, and eat slowly. Avoid greasy, high-fat, and spicy foods. When symptoms are not severe, follow a soft and bland diet that is low in fat: rice, noodles, pasta, mashed potatoes, clear soups, jello, clear fruit juice, ginger ale, crackers, pretzels, tea, dry toast, oatmeal, boiled eggs. For breakfast, eat crackers, dry cereal, or dry toast. Cold meals that have little odor are often easier to eat than hot meals. When symptoms are severe, it is important to replace the liquids and electrolytes lost: try saltines, pretzels, clear fruit juices, ginger ale or colas, caffeine-free Gatorade, clear soups. All liquids should be clear—that is, they should not be thick liquids like vegetable juices, citrus juices, some fruit juices, or milk. Drink them between meals rather than during meals.

Many drugs reduce nausea and vomiting. Some can be given by suppository in the event that nothing is retained when taken by mouth. Such drugs should be timed to meals; take them as directed, but try taking the drug after eating meals. Some useful drugs do not require a prescription; these include Dramamine and Pepto-Bismol. Other drugs require a prescription: antihistamines (such as Phenergan, Haldol, or Vistaril) or phenothiazines (such as Compazine), which are drugs that also reduce anxiety. Most of these drugs cause drowsiness.

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