Hello Doctor,

I am 35 and live in holland. Discovered was HIV+ in 2002. I was recently diagnosed with drug resistance to Efavirenz and Lamivudine, my regimen consisted of Sustiva and combivir and worked perfectly for 4 years till recently due to some cuts offs I developped this resistance to both drugs. My Doctor wants to switch me to Viread, Reyataz, Norvir and wants me to continue taking combivir, he is saying that since the AZT is still working that I should continue and the lamivudine will be most probably more effective for the ''mutant'' chain of viruses?!! My concern is that I already suffered fat loss from my hands and legs and a little bit from my face but since I work out a lot and maintain a very healthy lifestyle, it doesn't show a lot but to me it is obvious and sometimes it causes me some anxiety (some self esteem issues). I also have some stubborn fat deposit around my belly which I am fighting with aerobics, L-carnitine and a low fat diet, results are ok but not satisfactory to my level. My concern is with this new regimen and the reputation that some of these drugs I am taking would increase fat deposits around my belly, the high triglycerides in my blood and the ''yellow eyes'' syndrome. Can you please shed some light on the side effects of this regimen? Thank you for your answer and all the help you are providing.

Continuing the AZT could contribute to fat loss so sometimes a aough choice needs to be made. Often switching the AZT to tenofovir may help the fat issue some. Tenofovir can lower the atazanavir levels though with ritonavir boosting the levels are usually good enough. Using Kaletra (lopinavior/ritonavir) or ritonavir/Lexiva with Truvada (tenofovir + FTC) avoids any negative drug interactions from the ART perspective. Much of the fat related problems comes from the NRTI backbone with Truvada (or Epzicom= 3TC + abacavir) usually being more fat friendly. Another PI option is either ritonavir boosted daurunavir or saquinavir depending on what is available/approved in Holland. Often the first order of business is get suppressed again and then work with the regimen to try to make it as well tolerated and fat friendly as possible.. KH