First of I like to thank you very much for your time. My brother in Africa started treatment in Feb 2002 with Combivir and Sustiva, his CD4 was 117 at that time and after taking his med religiously his CD4 increased to 485 in August 2002. he discontinued his med on October of 2003 and CD4 decreased to 380 in December so he went to his Dr. and the Dr. changed his Med to DDI, D4t and Viracept. He is doing fine with this med but his face is getting skinner and skinner and darker. It bothered him so much and we are all worried about him. Please I don't know which other Med is available in the country, what is your advice he should do? Can he change his med to another med. I don't think there is a resistance test in the country. Please advice. Thanks a lot.

It is not clear at this point whether he is actually resistant to nevirapine. That being said I would see if a boosted protease inhibitor regimen is available locally (such as Kaletra or ritonavir + indinavir or saquinavir) which would often be preferable to Viracept and would more likely allow your brother to switch off the d4T which may be contributing to loss of facial fat (could go back to the Combivir and also see if tenofovir is available). KH