Dear Dr. Conway, Thank you very much for your reply to my previous question. You mentioned two possible causes, the first being a continuation of lipoatrophy from my previous combination. I think this is less likely as I had a treatment interruption of a year during which time some fat returned. Secondly you said that perhaps the Ritonavir could be causing the lipoatrophy and maybe I could have a regime where it was not necessary, could you please give me an example of what that might be? Would it be possible to have a solely PI regime? Is it possible to take only atazanavir and saquinavir without a ritonavir booster? Thank you very much again for your advice and time!

In the setting of an undetectable viral load, single drug switches to address issues of side effects (including lipodystrophy) are possible. In this context, the use of unboosted atazanavir is possible, substituting it for the boosted PI. The use of unboosted saquinavir is never indicated, due to very low blood levels of the drug. If the atazanavir option is not available to you, another consideration to avoid ritonavir is to use a non-nucleoside-based regimen, using efavirenz or nevirapine.