My apologies for sending this question several times. I was not clear about my condition and question. I currently switched from Sustiva/Truvada to Virmune/Truvada thinking my muscle fasciculation was being caused by Sustiva. I get muscle fasciculation accompanied by a sharp pain in my right tricep area, and sometimes some fasciculation without pain in my left tricep area and left calves. Sometimes I feel as if my body is on a low throttle when I lie down to sleep. I now think its Truvada and not the Sustiva because I have been reading about Lactic acid in the blood. My CD4 is 359 and vl 0.75...but my Metabolic Panel is showing my ALK Phosphatase results abnormal level of 98 which shoud between 25-90 U/L and my bilirubin level is 0.2 which should be 0.4-2.0. Before I go looking for trouble with a neurology, I need to make sure my findings are correct. I encounter the muscle fasciculation/twitching more when I work out for 45minutes on an exercise machine that allows you to workout arms/legs/chest... I forget the name of this exercise machine... you hold on to the handle pulling while your walking. I used this machine for over two years and never encountered a problem... but I notice my ALK Phosphatase increased since taking Sustiva/Truvada two years ago...before taking this combination my level was only 58. So please tell me I am not crazy... and may need to come off of Truvada...and what med i can replace the Truvada with... doctor tells me no such thing as lactic build up...and I respect ... but at the same time... i am dealing with this fasciculation/twitching for 4 weeks now. Should I demand to see a Neurologist? Thank you again and sorry for the trouble. smile ...

It is possible that an individual patient may be susceptible to effects of particular nucleoside reverse transcriptase inhibitors even if the drugs involved rarely have been reported to cause much in the way of mitochondrial toxicity. The local nature of the pain would unlikely be due to drug toxicity. The Alk phos elevations are not very helpful in sorting out the problem. I would request further evaluaton from a neurologist or a rheumatologist. KH