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Can I stop any meds that may contributing to lipoatrophy?
Feb 1, 2011

I would like to know if any of these meds are contributing to my lipodistrophy - Norvir,Viread,Lexiva,and Epzicom I have been hiv for 24 yrs and have been on many different meds. My t cells or over 900 and viral load is nondetectable. I don't want to be on any that are causing further problems with facial wasting.

Response from Dr. Pierone

Hello, and thanks for posting.

You are currently on what would be considered a 4 drug regimen for treatment of HIV infection. Norvir and Lexiva count as one drug because the Norvir in low dose simply boosts the drug levels of Lexiva to make it more effective. HIV is typically treated with 3 active drugs so the first question is whether you need to be on so many medications. If you have multi-drug resistant virus, a 4 drug combination may be appropriate.

Epzicom contains Ziagen (abacavir) and Epivir (lamivudine). These agents are nucleoside reverse transcriptase inhibitors. Viread (tenofovir) is a nucleotide reverse transcriptase inhibitor. All of these "nukes" are associated with lipoatrophy to varying degrees. The worst offenders in this class are ddI (Videx), AZT (Retrovir), and d4T (Zerit) and the good news is that you are not taking any of them.

Because of the association of nukes with facial lipoatrophy there has been increased interest antiretroviral treatment that does not contain any of these medications. One example of a nuke-sparing regimen would be a boosted protease inhibitor (like Novir-Lexiva) and Isentress (an integrase inhibitor). Another would be Intelence (a non-nucleoside reverse transciptase inhibitor) and Isentress.

The problem is that we don't yet have many studies of nuke-sparing regimens. However, the studies that have been performed so far, in most instances, have demonstrated similar rates of viral replication control with these regimens compared to standard nuke-based treatments.

It would be worthwhile for you to discuss options such as these with your doctor.

Good luck!



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