Hello, Doctors!

I started a new regimen seven weeks ago which includes Kaletra (4 pills, 2x a day), Viread (1 pill daily) and Sustiva (1 pill daily). Preliminary blood tests (after 2 weeks) showed very good results (VL nearly undetectable after 2 weeks and CD4 around 560) and good liver function. I had problems with Viramune before, so I'm very wary of changing meds.

I have two questions for you. First, although my initial fears about Sustiva have been mostly unfounded (scary dreams, strange thoughts), I have had ringing in my ears non-stop since beginning this regimen. Will this eventually stop?

Secondly, and more annoying, I have had diarrhea since day one on this regimen as well. I'll have to run to the bathroom several times in a day. These are not the sorts of surprises I enjoy! I'm guessing it's the Kaletra. Is that the most likely culprit? Should I switch to Reyataz, even with its higher chances for elevated bilirubin? I got high fevers and jaundice after 2 weeks on Viramune, so I'm a little gun shy about liver issues.

I'm also nervous about taking over the counter drugs for the diarrhea like Immodium for the long term. The Immodium works for a day or two and then the diarrhea starts again. I've let it go as long as 8 or 9 days to see if it stops on its own and it doesn't.

To fill out the picture, unfortunately the only Nuke against which I have no resistance is Viread. The Non-Nukes and PIs are all good.

Your advice would be most appreciated. Thanks for all your hard work!

You can consider changing Kaletra to Novir/Reyataz and this switch usually takes care of the diarrhea. The elevated bilirubin from Reyataz is not a significant problem for most people and occurs via a very different mechanism from Viramune-induced liver toxicity. Best of luck and let us know how it goes.