Hi from Croatia. I am 34 yo male. I have been on anti HIV meds (efavirenz, abacavir, 3TC) since february 2004. until march 2007 when usual screening show ALT over 700 and AST over 200. Never had eleveted enzymes before. Ultrasound of liver and hep C (even PCR)testing was done, together with autoimmune disease test but all came back negative. Doctor recommended drug holiday so I was off meds for past 9 months and liver enzymes returned to normal levels but my cd4 drop to 290 (from around 500 and undetectable VL before stoping treatment)and it was time to start again with HAART. Resistance testing show no resistance. After only two weeks on same HAART as before treatment holiday (EFV+ABC+3TC) liver enzymes has rise again. ALT to 130. My ID specialist thinks I need to switch efavirenz with kaletra as soon as possible as the first step in detecting which drug is causing liver toxicity in my case. Do you think it is a good aprroach or could it be that abacavir is more likely to cause this side effect because of allergic reaction (though no other symptomps)? And what are my options knowing that all anti HIV meds can cause liver toxicity. Ultimately is it liver transplant one of the options to consider? Thank you for your answer.

Is there any sign of hepatitis B or fatty liver (other common causes of liver elevation in this setting)? Trying Kaletra instead of Sustiva (efavirenz) or Truvada instead of abacavir/3TC0 are reasonable options to consider if no other possible cause of liver problems are found. KH