Dear Doctors: I have been Hiv+ since at least 1987 and have gone through the gamut of medications which I started in 1992. I am currently on Sustiva, Zerit, and Epivir. I started this regiment in March of 1999. VL=undetectable, CD4's=570. The problem I am having is severe pain and weakness in my elbow joints which extend up into my shoulders at times. I am having trouble sleeping and usually toss and turn at night. I have read that certain HIV meds can cause arthralgia or arthritic type problems. I have tried aspirin, Tylenol, Aleve, Nuprin without much help. My doctor gave me Ultram which did absolutely nothing but give me severe headaches for the two weeks I took it. I get more pain relief from the aspirin and such. Is there anything I can do to alleviate the pain and get back to normal? This has been getting progressively worse for the last 4 months or so. Can you suggest something? P.S. I would hate to have to come off the meds (if they are the cause) because I don't have many options left and I seem to be doing fine otherwise on them. And for the benefit of your other readers, I still have the Sustiva nightmares and very vivid dreams on occasion even after 9 months of treatment and also the very uptight, anxious feeling many people complain about. Just thought I'd pass that on. Thanks for your help.

Arthralgias (and frozen shoulder syndrome) were first reported with protease inhibitors but really thought to be due to immune reconstitution (increases in CD4 cells). Acetominophen (Tylenol) is not very helpful for inflammatory conditions and over-the-counter Aleve and Nuprin are not strong enough to have an anti-inflammatory effect - you may require a prescription strength anti-inflammatory agent. Tramadol (Ultram) is more of a pain killer than an anti-inflammatory.

TNK