Hello, I started my meds 2 years & 3 months ago. Till now no change of combination. These days I noticed my cheeks became sunken. Strange but it seems the left is more sunken than the right one. Do you think it is normal in lipoatrophy or I am just paranoid? And one more question - I know my combo is often related to lipoatrophy/videx,epivir,kaletra/ and probably 2 years are enough for develop it but do other factors help the lipoatrophy development - like alcohol and smoking for example? Sorry for such stupid questions but in my country I regret to say people can not count on doctors. And thanks for your time and professional help!

Hello, and thanks for posting.

It does sound like you have the beginning of facial lipoatrophy. It is not uncommon for there to be a difference in the degree of lipoatrophy when one side of the face is compared with the other.

Smoking will accelerate facial lipoatrophy and development of wrinkled skin as well. Excessive alcohol consumption will also lead to more rapid development of facial lipoatrophy.

The agent in your cocktail that is linked to facial lipoatrophy is Videx (ddI, didanosine) and if this could be switched (or stopped since there are good data on the effectiveness of Kaletra monotherapy or Kaletra plus one nucleoside). If you and your clinician decide to switch the Videx, see if Viread (tenofovir) is available for use. This medication would be the least likely of the nukes to cause lipoatrophy (compared with AZT and d4T).

I hope that this information helps and best of luck!