I have gained a huge amount of weight /fat whilst on Sustiva, 3TC and Ziagen. I changed the Ziagen for AZT recently and found that the fat gain (everywhere but my face and legs has remained the same). I have tried dieting and some excercise but it is very difficult. Is it sensible to get off Sustiva/Effavirenz for a while and change it with Nevirapine? I am starting to get desperate with this.

Hello, and thanks for posting.

One consideration for your situation is to change to an integrase inhibitor-based regimen. Raltegravir (Isentress) causes less lipid elevation than Sustiva, so it may also produce less fat gain (although we do not have proof of this yet). Changing Atripla (Sustiva + Truvada) to Isentress + Truvada might be a reasonable first step to take.

AZT would probably just exacerbate the lipodystrophy because of its known propensity to cause mitochondrial toxicity.

My personal view is also that overmedication occurs often in the management of HIV infection. It is not uncommon to see people on a 4 drug regimen when only 3 are necessary. A number of studies have shown that 2 highly active agents work as well, or almost as well as three drugs. There is also a growing body of evidence supporting the use of boosted protease inhibitor monotherapy for treatment of HIV infection. The drug companies are not going to fund these trials because of a potential loss of revenue. Unfortunately, the leadership for HIV research in the United States is dominated by a very conservative group of doctors ("the old white guys") who are not interested in exploring the potential for using fewer medications to control HIV replication.

Good luck!