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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Elevated LFTs
Mar 14, 2007

I am a 45 yo HIV+ male recently started on ARV therapy with Epzicom and Reyataz. I responded well virologically however have had steadily increasing LFTs particularly ALT (approx. 200). We stopped the Reyataz and substituted Sustiva and after 1 month my ALT continues to climb. Now we plan to replace the regimen with Atripla ( I guess switching Abacavir for Tenofovir. Does this approach make sense to you? Should I expect to see improvement? Might it be better just to stop the regimen (my CD4 is ok) to allow the numbers to normalize before starting something else? Thanks in advance for your advice!

Response from Dr. Henry

Many conditions besides HIV med side effects can cause an increase in liver enzymes. Alcohol use, fatty infiltration,a range of viral infections, gall bladder or pancreatic dysfunction, and many other conditions can cause LFT elevations. Physical examination, history, and futher lab or imaging studies are often helpful to sort out. Immune reconstitution can sometimes cause LFT elevations. The elevations you report are modest and often treatment would be continued while the work up is under way. Starting and stopping HIV meds can cause its own set of problems so generally once treatment is started it is continued if possible. HIV specialists are generally well versed at managing these complex situations to help out an individual patient. KH

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