Question:

Dear Doc,
I am on triple combination therapy (Crixivan + Ritonavir (soft gel) + Efavirenz) and have experienced chapped lips and a bitter taste in the mouth with food intake. The problem is especially bad when I eat vegetables. I have highlighted the problem to my doctor but we have not been able to solve the problem. Would you be able to advise on this? Is there anything I can take to solve, if not to ease the problem?

Answer provided by:

Ross Slotten, M.D.
Klein and Slotten Medical Associates
Private Practice in Family Medicine
With a special interest in HIV disease

You describe a taste disorder and chapped lips since taking Crixivan, Norvir and Sustiva. Taste perversion has been described in clinical trials of Crixivan and Norvir, three per cent of the time for the former and eleven per cent of the time for the latter. I could not find any evidence that Sustiva adversely affects taste. These are not the only medications that can affect taste--captopril, which is used to treat high blood pressure (and presumably other drugs in the same class, ACE inhibitors), and drugs to treat rhythm disturbances of the heart, have also been associated with taste disorders. Common problems like hypothyroidism and diabetes and less common conditions like kidney or liver failure can also affect taste; but you would have mentioned such problems in your letter. As for the chapped lips, Crixivan is the likely cause, since its effects are similar to Accutane, a Vitamin A derivative. Vitamin A, in high doses, can cause skin dryness and chapped lips. The only solution would be to change medication regimens, though it's not clear from your letter that this is possible (perhaps you have multidrug resistance). Whether your symptoms are reversible, even if you change medications, is also uncertain. This is a quality of life issue. You and your doctor will have to weigh the benefits and risks of your HIV therapy.

Sincerely,
Ross Slotten, M.D.

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