dear doctor,I started treatment in july 2004.It consisted of sustiva and truvada.It was easy to take and from what i have read is associated with low facial wasting.Unfortunately I could not take the sustiva due to really bad depression.My doctor switched me to lexiva-norvir(100mg) with truvada once a day.he said my cd4s were to high to go on viramune.I am toleratating the lexiva norvir well, yet I am scared about facial wasting and lipo on this combo.Do you know if this combo causes this? He says no.If it does I might want to ask him about viramune again.Please respond . Thankyou

Hello,

Our understanding of the exact causes of lipoatrophy (fat wasting) remains incomplete, to put it politely. What we do know is that certain HIV meds are much more likely to be associated with lipoatrophy than others, the biggest culprit being D4T. There are other factors involved as well. From a drugs that are associated with lipoatrophy perspective, your current regimen, Lexiva/Norvir and Truvada, looks good. However these medications are relatively new, so we are still learning about potential "longer term" toxicities and side effects. Stay tuned; we'll keep you posted if new information becomes available. For now it appears you're on a good regimen, which hopefully will suppress your viral load to undetectable limits and allow your CD4 cells to continue to climb while not inducing significant lipoatrophy.

Good luck.

Dr. Bob