Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date. I am currently on Truvada, Didanosine, Reyataz, and Norvir for treatment. My cd4 count is 780 and viral load 2000. I was on Sustiva and Combivir for the first four years of my treatment. Since the change in my regimen I have suffered from extreme heartburn and a protruding stomach. I currently am also on treatment for a hiatal hernia which includes Aciphex and Ranitidine. I should also note that I also take Claritin, Flonase, Albuterol, and Flovent for asthma and allergies. My question to you is whether or not this new treatment is causing these new symptoms? My doctor tells me the new meds should not be causing my stomach protrusion and pain. I do not see my Gastroenterologist for a few weeks. Is there anything I can do in the meantime to alleviate these problems?
Trevor Hawkins, M. D.
Associate Clinical Professor, Dept. Family Practice, University New Mexico
Medical Director, Southwest CARE Center, Santa Fe, NM
I do have some significant issues with what you are taking.
1. As to the heartburn and protruding stomach-while the regimen is indeed generally well tolerated, some people have a reaction even to this low (100mg) dose of Norvir. Also, DDI can sometimes cause stomach irritation. The question is how much is it due to your hiatal hernia and how much the meds.
2. Aciphex reduces the blood level of Reyataz by 76%. Ranitidine also reduces Reyataz levels. Truvada contains Tenofovir which also reduces Reyataz levels. If, as seems likely, you need the Aciphex and ranitidine, you should change your HAART regimen.
3. Because your viral load is 2000, you should get a genotype test to determine whether you are resistant to any of the drugs you are on BEFORE you stop the regimen.
4. Truvada and DDI have a tendency to select for the M184V and K65R mutations when given together.
To summarize, get the genotype, stop the regimen, see if your stomach symptoms get better, check with your gastroenterologist, restart a new regimen if needed based on the genotype and whether you need to continue to take meds like aciphex.
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