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Pulled off meds because of drug induced hepatitis

Nov 2, 2008

I started Reyataz/Truvada/ Norvir 9/26/08, last week a routine liver function test came back abnormal, ALT-540, ALP-197, the bloods were repeated and came back ALT-394, ALP-157. I was taken off all meds straightaway. My doctor is repeating LFT's twice weekly. I had previously been on Truvada/Kaletra and then Truvada/Sustiva with no liver problems. I don't drink alcohol, I take no other meds except Citalopram. Do you have any idea how long it will take for those numbers to come down? I'm keen to get back on a new combo as soon as possible. The doctor said my liver would go into 'meltdown' if I start a new combination too soon. Are my numbers that bad? My gut couldn't tolerate Kaletra, my brain couldn't tolerate Sustiva and now my liver can't tolerate Reyataz, any idea what I could try next? My other bloods: Feb 08 CD4 230 9% VL 3.5MILL Mar 08 CD4 440 6% VL 660K Apr 08 CD4 420 11% VL 3MILL Jun 08 CD4 200 7% VL 3MILL July 08 CD4 250 14% VL 24K Aug 08 CD4 410 15% VL 4313 Bearing in mind these how long off meds do you reckon before I get resistance and the numbers go bad again? Thanks for your time.

Response from Dr. Holodniy

Given your prior experience with truvada, norvir (it was in the kaletra), it does appear that reyataz is the suspect. It should not take too long for your liver functions to normalize (a few days to a couple of weeks, unless something else is acutely going on). I don't think HIV drug resistance will be a problem if you stop everything while your liver cools off. The simplest move is to just swap out the reyataz with prezista (darunavir). It could certainly cause GI or liver problems, but you wouldn't know until you tried. Another move would be to keep the truvada and start issentress.

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