I have taken Crixivan for 6 or 7 years with little side effects. 3 years ago, I switched to a combination or Crixivan and Norvir to eliminate an eating schedule. Is Crixivan the culprit causing wasting, particularly facial wasting? Or, do all protease inhibitors have this effect? If not, what is the cause? And, are there any PIs that don't contain this side effect?

Medication combinations are complicated to pull apart as individual risk factors. A recent report suggested that combinations that include indinavir (Crixivan) may alter fat cell differentiation. In this same report, the authors state that the effects of combinations may be different from what each drug may do on its own. And, while it has been suggested that medications are a risk factor, they are not the only items associated with fat alterations. Even within a class of drugs, the drugs may have different types of effects on body fat production and deposition.

Other risk factors include age, sex, history of complicating hormone changes (diabetes, testosterone, etc), viral load, CD4 count, other lab values, smoking, drinking alcohol, and others. Some you can change, some you can't.

Keep a close eye on how you are doing with your regimen. Get some measures done (anthropometry: circumferences and fatfolds) periodically to keep a record of any changes. Report any changes to your team in a timely manner. And, consider shoring up some risk factors that you can change, such as smoking and drinking alcohol.

Best wishes!