Hello Doctor, i m a 52-year old male, hiv positive diagnosed Jan 2014. Viral load was around 5,000 and CD4 210. Started taking Atripla almost straight away, which has reduced the viral load to undetectable, and my CD4 has improved slighty, although it s still early days. I am generally feeling pretty good, but have a concern regarding a change in my bowel habits. From mid March to mid April, bowel movements were somewhat concerning. Below, is a copy of the diary i kept. March Sun 16th During the morning 4 or 5 loose bowel movements, took 1-immodium tablet. Later in the day stomach quite bloated and uncomfortable after a bike ride and protein shake. Mon 17th Stomach still uncomfortable. 11am - bowel movement, normal consistency but felt I couldn’t empty completely. Dull ache in legs, bottom of back and bottom after bowel movement. 1.15pm - loose bowel movement, again doesn’t feel like I’ve emptied my bowels. 4.15pm – excess gas and mucus expelled. 7.15pm – diarrhea, 5-mins later need to go again. 8.15pm – a little more diarrhea and mucus. Tues 18th 7am – expelled excess gas. 12.15pm - expelled massive amount of gas. 1.45pm - expelled massive amount of gas, followed by a 4-pellet bowel movement. 9pm – almost normal bowel movement, rapidly followed by diarrhea. Stomach’s been rumbling and have been expelling massive amounts of gas all evening. 10.30pm - expelled massive amount of gas, followed by diarrhea. Quite mucusy when wiped. 11.30pm – more diarrhea. Weds 19th 12.30pm – expelled a lot of gas, followed by a thin bowel movement. 1.30pm - expelled a lot of gas, gut rumbling. 4.45pm – expelled a lot of gas, and bowel movement. Colour quite pale and thin. 5.50pm – excess gas and diarrhea. 6.30pm – expelled excess gas. 7pm – gas and diarrhea. 9.15pm - another loose bowel movement and excess gas. Thurs 20th No bowel movements at all, just a little gas. Fri 21st 7.15am - bowel movement, difficult to empty. A couple of minutes later went again, consistency normal but pale brown. Looked like blood smeared on some of the stools (probably due to haemorrhoids). Doesn’t feel like bowel has emptied. 2.00pm – following lunchtime walk, a fair bit of gas expelled and a massive amount of diarrhea. Stomach a little uncomfortable. Sat 22nd 8.15am – normalish bowel movement, a little loose towards the end. Looked like blood smeared on some of the stools (probably due to haemorrhoids). Gut gurgling. 9.05am – small loose bowel movement. 10.10am – diarrhea. 11.45am – small bowel movement, pellet type. Stomach a little uncomfortable. 2.30pm – diarrhea, bottom hurting and lower back. Legs aching and stomach still uncomfortable. Sun 23rd 11.30pm – bowel movement normal, loose towards the end. Mon 24th 9.45pm – bowel movement, started normal, but soon turned to diarrhea, quite a lot of it. Tues 25th 1.00pm - normalish bowel movement, followed by loose. Weds 26th 1.15pm - excess amount of gas and normal bowel movement, although difficult to pass. 2.00pm - excess gas, very smelly. 2.45pm – diarrhea, mucusy, when wiping stimulated more to come. Thurs 27th 2.50pm - loose bowel movement and diarrhea. Fri 28th No bowel movements at all, just a little gas. Sat 29th 6.10am - normal to loose bowel movement. 8.15am - loose bowel movement. 9.15am - loose bowel movement to diarrhea 12.30pm - small loose bowel movement. 2.45pm - small loose bowel movement. Pain today in lower legs, lower back and bottom. Sun 30th 8.30am - normalish to soft bowel movement, pale brown. 9.30am - soft bowel movement to diarrhea, very mucusy. 8.30pm - liquid diarrhea, stomach uncomfortable. 10.30pm - liquid diarrhea. Mon 31st 1.15pm - normal to soft bowel movement. 4pm - soft bowel movement. 5.45pm - large amount of diarrhea and sloppy bowel movement. 6.45pm - small diarrhea. 8pm - small soft bowel movement. 9.30pm - diarrhea. April Tues 1st No bowel movements at all, a little gas and stomach rumbling. Weds 2nd 7.30am – normal to soft/sloppy bowel movement, stomach a little uncomfortable. Thurs 3rd 7.30am – normal to soft bowel movement. 8.30am – soft bowel movement to liquid diarrhea. 12.00 midday – small normal to soft bowel movement, stomach a little uncomfortable. 1.20pm – diarrhea. 2.20pm – diarrhea. Fri 4th No bowel movements at all. Sat 5th 9am - normal to soft bowel movement. 9.45am - diarrhea. 12.15pm – small loose bowel movement, followed by diarrhea. Sun 6th 11.15am – mushy bowel movement. 12.30pm - small mushy bowel movement. 3pm - diarrhea and pencil thin bowel movement. Mon 7th 8.15pm - normal to mushy bowel movement. 10pm - mushy bowel movement, foul smelling. Tues 8th Didn’t record any bowel movements. Weds 9th No bowel movements at all. Thurs 10th 7.30am - normal to soft bowel movement, very pale/yellowish. 8.45pm - large bowel movement and mushy. 10.30pm - mushy bowel movement, very mucusy. Fri 11th 7pm mushy bowel movement. Sat 12th 10.30am - normal to mushy bowel movement. 12.30pm – small mushy bowel movement. Sun 13th 8.30am - normal to mushy bowel movement. 10am - mushy bowel movement. 11am - mushy bowel movement. Diet mainly consists of: Breakfast – Porridge oats with milled seed and honey. Lunch – 2-wholemeal cobs with chicken or tuna and cucumber, celery sticks, tomatoes, 4-5 pieces of fruit. Fruit normally eaten in rapid succession. Dinner – Pasta, sausage and veg, chicken and veg, spaghetti bolognaise, fish, rice and veg and a yogurt type desert. Drinks – mainly decaf tea and water. Exercise – walk out most lunch times and go to the gym once a week, plus cycling at the weekend. Job mainly office based. Medication: Atripla - 1 per day, taken between 10 and 11pm Tamsulosin - 1 per day, taken with breakfast, this is for Benign prostatic hyperplasia Finasteride - 1 per day, taken with breakfast, this is also for Benign prostatic hyperplasia