49 years old african lady known HIV seven years ago came to our clinic two weeks ago for second opinion.She is complaining of sever progressive right ankle arthragia with generalized prephral neuritis for the past six months. She is walking with assiactance.No swelling or hottness in the joints.She didn't show any responce to NSAIDs or Amitrypaline.CBC , uric acid normal. ESR 10mm/hrs. Rheumatoid factor, TB antigen , Cryptococcal. Toxoplasmosis are negative.Past H. of CMV retinitis treated with ganciclovir. ARV H. She started on 2002 on Neverapine 200mg ,Lamuvidine 150mg and Stavudine40mg Bd up to 2003 then shifted to Combvir and Ziagen up to 2004 then from Jan. 2004 started Kaletra ,Lamuvidine and DDI.The reason for that changes is unknown. CD4 count is 240 Viral load not available. I suspect DDi could be the reason .What is your opinion? if it need to change DDI what wil be the best regime putting in mind the resistance test is not available in Zambia. Thank you

DDI and to a less extent 3TC can contribute to peripheral neuropathy. If possible a switch to abacavir or tenofovir or even AZT might help some. I have some patients on double boosted PIs in that setting (such as adding saquinavir to atazanavir to Kaletra) if that is available. If those drugs not available can try to decreae ddI dose and treat with amitryptiline can help some. KH