Atripla - Chronic Diarrhea for 4 months - pls help - im lost!!!!!

[Delby]

Hi Everyone,

I began Atripla in Feb 08 and apart from experiencing several ongoing side effects such as fatigue, insomnia, anxiety etc...my biggest issue now is the Chronic Diarrhea i am experiencing every single day.

I am really really struggling. I am making the trip to the toilet between 5 - 15 times per day. Each time my stools are watery and loose. I have passed a solid stool for approx 4 months. There has been no let up of symptoms. Each and every day without fail i have diarrhea.

In my last clinic appointment I informed my Doctor of this, and he told me that he doubts its the HIV or Atripla as it is a drug combination not readily known for causing ongoing diarrhea. Thats funny, i could have sworn I read in the insert - 'Common Side Effects include Diarrhea' - Must have been a misprint then.

In any event he prescribed me a course of treatment just in case i had any parasite infections. Took a stool sample and sent me off. The stool sample came back negative and despite the course of treatment, my diarrhea is still continuing unabated. I called the doctor and he has now referred me to my GP so they can in turn refer me to a Gastroenterologist for a Colonoscopy and Endoscopy. I am really frightened and worried as i did a bit of research on old threads on Poz, and noticed that most people dont suffer with Diarrhea when on Atripla.

It really doesnt help that I have a Doctor who doesnt really show much compassion towards me. Despite me trying to contact him to ask him for advice on any supplements or anything I can take to help alleviate the symptoms, i've had no response. I feel very alone and without support.

I have tried immodium several times per day and it does absolutely NOTHING to help me. Can anyone suggest what my doctor should be advising me. Is he right to book me in for an Endo/Colonoscopy or should he be performing blood tests or other tests? Also, is there anything anyone can recommend to take to help with chronic diarrhea?

Is this something i will just have to live with now, or is there something i can do? Its getting so bad that sometimes i dont make it too the toilet in time. Please can anyone offer advice, on whether this is normal for an Atripla regime.

Thanks

Delby 

[Finnboy]

No you shouldn't have to live like that and it sounds to me like you need to find a new doctor; but, in the meantime, try to up your intake of soluble fibre - apples, barley, citrus fruits, guar gum, legumes, oats, pears, strawberries etc. - which contain gums and pectin which act as binding agents to help keep your stools formed and bulky.

As for the suggestion that diarrhoea isn't a common side-effect of your combination of drugs: the answer is that brown stuff you are sitting in. It may not generally be as dramatic as what you are experiencing, but it is certainly common enough.

NB: Soluble fibre is not to be confused insoluble fibre, which keeps your stools soft and prevents constipation. Both are essential, but they serve different purposes. Oats are a good compromise as they provide an abundance of both fibres, whilst still helping to keep the brown stuff regular, soft and formed (and being exceptionally good for the heart too).

The other thing I am wondering about is whether the balance of your gut flora has somehow been upset (perhaps after taking a course of broad spectrum antibiotics?). If this is the case, it may also be worth your while adding a probiotic yoghurt (or probiotic yoghurt drink) to your diet for a few weeks - but make sure you get a reputable brand, because half the cheaper brands are about as biotic as washing-up water.

Seriously though, explore the possibilities of finding a new doctor.

[jabez]

I ain't a doctor, but I'll tell you my early experience with Atripla.   In September 2007, I had a CD4 count of 68, and my doctor put me on a preventative antibiotic known as Bactrim.   About three weeks later, I started taking Atripla. 

The first couple of days with the Atripla, everything was fine.  But on the third day -- a Sunday afternoon -- the squirts began, and it was AWFUL.  I probably went to the bathroom six or seven times that evening.   The next couple of days were just as bad, and I was ruinining all of my undershorts.   I could NEVER make it to the bathroom in time.   I've never experienced such an ''outpouring'', and I had no idea what to do about it.   I bought some Immodeum, but it didn't help much.   I started reading everything I could about how to manage the side effects of HIV meds.   On the lessons page here on AidsMeds, I read about the BRAT diet, and decided to start eating a couple of bananas everyday.   I also "tweaked" the diet by adding a cup of yogurt every morning and a handful of nuts (either peanuts or pecans) every afternoon.   It made all the difference in the world.  Almost immediately, my bathroom pattern changed from going to 5 to 10 times per day, to about twice per day.   The stools were still watery and soft, but they came only early in the morning and late in the evening, rather than around the clock.

This went on for about six months.   Finally, it became apparent in the Spring of 2008 that my CD4 count was staying well above 200, so the doctor told me to quit taking Bactrim.  Guess what?  Problem solved!  Evidently it was the Bactrim (or the combination of Bactrim and Atripla) that was causing the diahrrea problem.   You'll hear a lot of people say that antibiotics tend to upset their stomach, and I found that Bactrim was no exception at all to that rule. 

These days, everything is cool.

You didn't mention whether or not you're taking any antibiotics --- if you are, then the antibiotics could definitely be the culprit causing the loose stools.   You might also want to try utilizing some tips from the BRAT diet, because I can assure you that they really do work.   And above all, take whatever tests your doctor suggests, such as Endoscopys and things, to make sure that something else isn't wrong.

And best of luck to you!   I know exactly how you feel.       

[CWD6474]

I have had the same problem now, for going on a year, however I am not on Atripla. I have lost 40 pounds, I live in the bathroom, and still no results.

I was diagnosed as having MAC (mycoavium bacterium complex) This is why my doc says I go and go and go and go.  I have been on the antibiotics along with my regular drugs and still no stopping the going and going and going.

The only way I am able to function is I am spending over $80.00 a month on Immodium AD. If anyone can help me, please feel free.  I will take all advice.

I am on
Lexiva, Viread, Combivir, Prednisone, Potassium, Clarithromyocin, Xifaxin, and Bactrim.

Please help if you can

[Assurbanipal]

If Immodium is not enough, perhaps you should ask your doctor if there are other medicines that could help and don't conflict with your existing drugs.  Tincture of opium has been cited in several of the other diarrhea threads as quite effective. There may be others as well.  But the main point is that going to the doctor with questions about specific drugs to take care of this symptom may better focus him/her on the problem and how important it is.

I hope you can find something that works better for you.

[Delby]

Thanks for all that have answered so far.

I have and continue to try everything that is suggested to a person suffering from chronic diarrhea. I have removed lactose from my diet. I eat porridge every day for breakfast. I have cut down on caffiene (1 tea/day). I am following the brat diet. I am eating banannas. I am going banannas!!!!

I am currently not on any anti biotics but i do take Prozac and Mirtazapine every day, although i really doubt that they are the culprit.

I am at a loss. The next stage, my doctor informed me, is to have both a colon/endoscopy. He also says that my bloods indicated that I am not suffering from malabsorbtion. Thats very weird as i am going to the toilet between 5 -15 times a day. Also, my weight has remained quite stable.

My doctor managed to find the time to write to me today, informing me that aside from the 'scoping' i am due from the gastroenterologist there is nothing that can be done. He even said switching medication will not guarrantee helping.

So basically its a case of 'get used to it'!! I'm feeling very down and low, as there doesnt seem to be a light at the end of the tunnel. To be told this is how its going to be and 'sorry, but not much i can do' is very deflating. I dont know how much longer i can keep this up. Anyway, who am i too complain...just a 'number' and a case study at my local GUM clinic!

Anyone else that has had experience with this, i'm sure we'd all love to hear from you.

 

[BT65]

Delby, you might ask your doctor for prescription Loperamide (Immodium).  That helps as it's a much higher concentration of medicine than the o.t.c Immodium.  Also, make sure you're drinking plenty of water and maybe even something like Gatorade so you don't get dehydrated. Good luck.
  Luv,
Betty

[GNYC09]

Delby, how did you end up resolving this issue?  (I hope it was resolved!)  I also have had diarrhea since I started my Atripla nearly 6 months ago.  Luckily, I have it somewhat under control thanks to immodium, calcium pills, benefiber and digestive enzymes but would just like to stop having diarrhea period.  I am considering a switch to Intelence in the hopes that helps.  I wonder how you're doing now.  Thnx

[HollyStar]

Delby, I really hope that these issues have been resolved for you and that you found a new ID doctor.

I was on Atripla for several months and diarrhea every morning. Not nearly as bad as you but I finally switched due to several undesirable side effects. I switched to Lexiva and Truvada and what a relief it is! I still have soft stools but not as urgent, you know? And the Atripla pamplet does say diarrhea in the side effects. My doctor didn't think that should have been having these issues with Atripla and ordered tests but as I knew it was, it was the Atripla. Again, I hope everything worked out.

[Delby]

Well unfortunately after many tests and colonoscopy's and endoscopies i was diagnosed with having Ulcerative Colitis. I have Pan ulcerative colitis which is the worst form and effects the whole colon. Basically its a dreadful disease of the colon and bowels. It causes inflammation, ulcers and bleeding/diarrhea as a result.

So it wasnt the Atripla that was causing my dreadful diarrhea. As a result I have been on about 20 pills per day to try and get things under control, including high doses of steriods (which i;m on now), medicated enemas and anti-inflammatory's. I have ended up in hospital twice as a result of how severe things have got, and i will now have to consider having major surgery and having my colon removed and living with a bag attached to my abdomen to collect faeces for the rest of my years. Funny thing is, my UC causes me much much more problems than my HIV on a day to day basis. But then again, I would never have got UC had i not got HIV. So i'm dealing with two diseases both of which are very serious.

Delby

[GNYC09]

Oh my gosh    Delby, good luck with this.

[BM]

Had your doctor said if this is an immune reconstitution symptom?

[Delby]

Yes it was suggested that maybe it was IRIS (immune reconstitutuin) at the beginning. But the symptoms never abated after being on steriods for several months. Having also had several 'scopes' the GI has definately confirmed its not IRIS and unfortunately Pan Ulcerative Colitis. It really is a dreadful disease and its ironic that this should be causing me more problems than my HIV at the moment.

Be interesting to hear from anyone else that has HIV and UC? Anyone out there living with a colostomy bag as i would appreciate hearing from you as my options are quickly running out and surgery is now on the horizon.

[mpositive]

Real sorry to hear about this Delby.  I seroconverted with CMV Colitis which was absolutely horrible, lasted for a couple of months.  I can't imagine going thru that daily.  Hang in there and I wish only the best for you.
M

[Horizon]

Hi had a similar episode of 4 month diarrhea shortly after starting ATRIPLA. Gastroenterologist sent me for numerous stool sample that came back negative for infection.

Ask your GP to check your pancreas. My test revealed moderate pancreatic insufficiency that was possibly causing the diarrhea. After taking pancreatic enzymes for a few months, the situation resolved on its own and I stopped the enzymes
MEds can sometimes interfere with the pancreas, but this can resolve.
Also took a broad antibiotic at the same time, that may have also cured a hidden infection.