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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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What's causing.....?
Feb 9, 2007

For more than a year I have been experiencing nausea and chronic diarrhea. I take loperamide to battle the diarrhea. The diarrhea goes through a cycle of clearing up for a day or two, then returns with a vengeance and I start the loperamide over again to stop it, etc., etc.

Unfortunately I have had to start taking 4mg per event to stop the diarrhea from returning the next movement. Now, even that barely seems to help.

In addition to the new "normalcy" of having constant diarrhea it's getting worse. I have started having explosive diarrhea. I swear to you sometimes I think I'm going to shatter the toilet it comes out with such speed and force (please feel free to edit this part out). When I have the explosive movements I usually have great pain in my stomach right before I have to go to the restroom. On top of that my fecal matter has turned green for the last month, even when it's formed and relatively solid.

For the nausea, I've been on pretty much every drug known to mankind it seems. From Compazine to Phenergan (which puts me to sleep) to Protonix thinking it might be an acid problem. My doctor hasn't yet felt my nausea is bad enough to try something more substantial, and ADAP won't cover Zofran. They MAY cover Dronabinal, but that's a long shot since I'm not wasting yet.

Last, but not least, I am on Truvada and Sustiva.

So, what could be causing these problems? I would like to know so I can have an educated discussion with my doctor and help resolve these issues. If that should fail, then I'd like to know what I should tell a new doctor if I need to find one.

Thank you for all your hard work and this excellent resource. I'm not sure what I would have done without it when I learned I am positive. This site has taught me so much.

Response from Dr. Henry

I have cared for a small number of patients who have significant diarrhea from tenofovir (in Truvada). The other 2 antiretrovirals you are taking would be less likely to cause the diarrhea but they are an outside possibility. I would discuss with your HIV doctor whether any further GI work-up (ie gluten or lactose intolerance, parasitic infection, inflammatory bowel disease or other conditions excluded) is advisable and then consider a careful switch strategy (such as abacavir for tenofovir) to see if an offendind drug can be identified. KH

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