I've been HIV+ for 14 years in good health. I started triple combo therapy 20 months ago with Crixivan, 3tc and d4t. My viral load is undetectable and my CD4 count is over 300. About 8 months ago I began experiencing bloating and diarrhea, and it's now up to 10-15 times a day. After a colonoscopy and 2 endoscopies my doctors have concluded that, aside from a minor amount of gastritis, the reason must be the combo therapy. I've had no weight loss and anti-diarrheals have little effect, because they don't control the bloating and gas (the bloating clearly begins in the stomach with any intake, even water).

We're cautious about changing the drug therapy because, a) I'm doing well virologically, and b) I don't want to jump out of the frying pan and into the fire. Where can we get more information on this? Would you hazard a guess as to the immediate or base cause of the bloating? Or which of the three drugs might be most worth changing? Or steps we could take to control it?

Thanks for any information you have.

This is a tough problem. You could probably safely try a short "drug-holiday" to see if the symptoms get better without the combo...but then re-introduce a different combination to see if the symptoms recur. GI side effects are the most common side effects from the PI's, all the PI's unfortunately. You might be able to take a combo with a non-nuke like viramune or sustiva which do not tend to cause diarrhea. You could even try this approach without the drug holiday (switching from one combo to the other). Alvan Fisher, M.D.