How does one decide which of 4 drugs are causing side effects when it could be any of them? Regimen of atripla plus Ziagen-booster, after 8mnths of non detection w/575 CD-4's,am now having pervasive nausea, light headedness, palpitations when rising-up. Much fat loss in arms and legs and thighs. In 15 yrs sero + history and many regimens, have never felt this lousy. Doc says lets stop the Ziagen and see what happens. This regimen has yielded good #'s and I'm nervous to change. Thoughts?

Many of your symptoms are non-specific and would not implicate any one particular drug. If you are HLA B5701 negative it is quite unlikely that the abacavir is causing any form of hypersensitivity reaction. Ziagen is generally fairly well tolerated in the absence of the hypersensitivity reactions. If you have a history of failing previous regimens and are now undetectable one has to use caution when stopping drugs in an otherwise effective regimen. Also your current regimen would be expected to not have a major impact on fat loss. A good medical workup (hormone status, heart evaluation et cetera) is recommended to sort out other contributing causes to your many symptoms. Some of your symptoms could also be due to lasting effects of the efavirenz in the Atripla so another consideration would be to consider a boosted PI based regimen on a trial basis if no other causes are identified. KH