Dear Doctor,

First of all, what a good site!!! I have a question for you, i am on kaletra, epivir and viramune for almost two years and i have daily musclepain/weakness especially in legs and back.(burning, especially in the morning)Scan was ok, other tests also. I went to neurologist and all tests are normal, so that was good news but the musclepain which can be really painfull still hurts, could this be a side effect of these medicins and which one this my question? My viral load is ok and my cd 4 are around 400/500 so that is also good.I hope you can help me. MANY THANKS! Keep up the good work.

I assume you have had muscle enzymes checked as well as other inflammatory markers? Muscle damage (myositis or myopathy) is not particularly common with any of the 3 meds you are on. If no other explanation can be found I might consider a trial of dual boosted PIs alone (such as adding atazanavir). If symptoms get better then one of the other drugs was involved with your symptoms. If symptoms persist then maybe you have an unusual reaction to PIs and a PI-spring regimen could be considered on a trial basis. KH