Diarrhea likely from HAART regimen
May 11, 2011
Hi Dr. Henry, Thank you for what you do. I'm a 52-year-old white male with HIV. My T-Cell count has never dropped below what is normal, as I discovered I was positive shortly after I was infected and began a HAART regimen very early as compared to most people hoping it would help with some cognitive issues. My T-Cell count is currently in excess of 1000 and VL is undetectable. I started on Atripla and tolerated it well for about 2 years. I had sleeping issues throughout and for that reason switched to Truvada with Isentress about a year ago. I sensed that this combination was making me overly emotional and while my doctor said that she had never heard of that as a side effect, she willingly changed my regimen again to Norvir and Lexiva about six months ago. I have had diarrhea since then. Two weeks ago, due to the diarrhea and after a negative stool analysis, my ID switched me to Truvada with Kaletra. The diarrhea has not abated, though. I'm at my wits end. Do you have any suggestions for how to control this? I've always had a very healthy digestive system; that is, no history of chronic digestive issues, lactose problems, etc. I have experimented with skipping doses of my HIV meds and when I do, the diarrhea does abate, usually the next day. I'd appreciate your input.
Response from Dr. Henry
Ritonavir boosted protease inhibitors are associated with loose stools/gut complaints and can aggravate any pre-exisiting condition (such as mild lactose or gluten intolerance). Some patients (< 10%) seem to have gut complaints/loose stools from the tenofovir in Truvada. A trial switch from Truvada to Epzicom (if HLA B5701 negative) might be worth considering as well as a switch from ritonavir/Lexiva to an alternative regimne (ie ritonavir/atazanavir or raltegravir or nevirapine or etravirine or even mariviroc if CCR5 virus status at baseline can be determined). A GI consultation may be useful as well looking for other possible explanations. KH
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