Dr.KH I been on Kaletra and Trvada since July 2008 , now my virus is CD4 is 604 and VL is undetectable. I take 2 Kaletra and 1 Truvada in the mornings after breakfast and 2 kaletra around 10pm -I don't get that much diarrhea but sometimes after 1 or 2 hour after lunch I get stomach cramps and one explosive diarrhea , them the next morning my stool is normal again , sometimes I take imodium in the morning to prevent this situation, Should I switch to 1 Truvada and 2 Kaletra at night and 2 Kaletra in the Morning. Thanks.

For some patients a switch to an alternative protease inhibitor such as boosted atazanavir or darunavir might help with loose stools. Calcium supplements, increased fiber intake, increase in lactobacilli (yogurt or macrobiotics) may variably help some patients with intermittent loose stools possibly due to protease inhibitors. A subset of patients have loose stools from Truvada which may improve with a switch to Epzicom if appropriate otherwise. KH