Positive since 97. Viral load undetectable and cd4 near 700. Videx/Zerit mixture from 99-06 caused moderate to severe wasting. Switched to Atripla in 06. What would you recommend to keep numbers low and hopefully reduce wasting. Also have heart disease. Thanks in advance for any advice. Mike

Hello, and thanks for posting.

I wish that I knew of a better option for preventing further lipoatrophy in a situation like yours. My hunch is that a nuke sparing regimen would be less likely to perpetuate fat wasting, but there are no data to speak of. I would not be in favor of changing to a protease inhibitor because of the linkage with increased risk of heart disease.

I have treated carefully selected patients with a combination of Isentress and NNRTI (either Intelence, Sustiva, or Viramune) in order to devise a nuke and protease inhibitor-sparing regimen. Although this approach has been effective in controlling viral replication, I don't know if it helps prevent progression of lipoatrophy. So currently, if someone has lipoatrophy and is on Atripla, I treat the facial lipoatrophy with fillers, and generally continue the Atripla.

I hope that this information helps and good luck!