Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date. I am a 56 yr. old white male who after nearly 9 years of being on Crixivan, 3TC, and Videx EC has changed my regimen to Sustiva, 3TC, and Videx EC. My viral load has been undetectable since my start on HAART. I have changed to Sustiva as recommended by my doctor, as over the years, I have developed osteoporosis which he attributes to the Indavir. I have now been on the Sustiva regimen for 9 days and have experienced no adverse reactions as described in the literature to this drug, however, although I am having bowel movements frequently throughout the morning hours as I have experienced for years, they remain firm with one exception. Since starting the Sustiva my bowel movements have caused my rectum to burn. I am using toilet paper sparingly and wiping with moist wipes with aloe vera. This helps some as well as hot sit baths. However, the problem persists. I attribute this to the Sustiva. I do not have hemorrhoids. I do not see my doctor for another 4 weeks and want to address this annoying problem now. Any suggestions or is this something I am going to have to learn to live with? Thank you for your assistance.
Ross Slotten, M.D.
Klein and Slotten Medical Associates
Private Practice in Family Medicine
With a special interest in HIV disease
You state that you were recently changed to a regimen that includes Sustiva and the main side effect you're experiencing is rectal burning. I don't believe that this symptom is related to Sustiva per se, though the increased number of bowel movements might be a contributing factor. As you know, typical side effects of Sustiva are mainly neuropsychiatric, that is, vivid dreams, a stoned-like feeling, and fatigue. Sometimes people develop an allergic reaction to Sustiva, characterized by a generalized rash.
Since it's not possible to get more information from you, I can only make a stab at what I think is causing your problem. Most likely, you have developed a fissure, which can be very uncomfortable. Fissures are tears in the anal tissue, similar to a split lip, which can be quite painful. If you've been sexually active and have had anal intercourse, you may have picked up some sort of infection. Or, if you have a past history of herpes, your herpes could have flared. Whatever the cause, I suggest that you see your doctor well before your scheduled four-week follow-up visit. He/she may be able to treat you or refer you to surgeon, if the problem seems to be due to a fissure.
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