I'm currently on nevirapine (400 mg once a day), abacavir (600 mg twice a day) and didanosine (400 mg once a day). I lost subcutaneous fat on my face with D4T and my doctor switched it for Abacavir a year ago. Before switching to Abacavir, I also got a small buffalo hump under my neck. I still haven't noticed any changes toward recovering part of the facial fat I lost or a reduction in the hump. Would dropping didanosine and taking something different help in the process of fat distribution in my body? My viral load is currently undetectable and my CD4 count was 999 on my last test. Thanks for your help and congratulations on this wonderful site.

Fred

The jury is still out on the role of ddI in lipoatrophy or fat gains-I have seen data both pro and con so your question is a good one which I can't answer. Changes can be slow. The abacavir and nevirapine are generally very fat friendly so it is hard to know whether you would see much improvement by switching off ddI. In some cases I have put patients on double boosted PI regimens to drop the NRTIs all together--it is still unclear whether that is generally effective. Intervention that may help the fat loss may not do much of the fat gain elsewhere so simple interventions are lacking at present but a number of modalities are being studied (diabetes drugs, uridine, testosterone, growth hormone and others). KH