I have been HIV+ for 4 yrs. From the start I have been taking meds- right now Sustiva, d4t, and 3TC. Viral load under 50, CD4 is 766. Only change has been ddl to d4t 2 yrs ago which stopped the nueropathy. No other side effects except I am experiencing lipodystrophy-facial, temple, and gynaecomastia with painful swelling. Facial started 6 mos. ago, gynea. 1 month ago. My doc suggests switching to combivir and viramune. Which of the drugs I am on now are suspected to cause lipodystrophy and are any of the meds suggested by my doc suspects too? Any combo that may be best? Will a switch reverse, stop, or slow the condition? What else can I do to reverse, reduce, stop, or prevent the lipodystpophy? vitamins? exercise? others? What about plastic surgery- don't really want to go there though! I know...lots of questions, but any suggestions are appreciated. Thanks!

While it is likely that there are a combination of factors at work leading to loss of fat, the drug you mentioned that has been listed as suspect for these problems is d4T. It is also likely that there are other risk factors, some of which you may be able to do something about. Switching medications to another combination is one of the treatment possibilities that many physicians support. In addition, your efforts to improve a healthy lifestyle, such as eating well and exercising (and even quitting smoking), can support a good result. A couple of groups are looking into the possibility of hormonal modulation with rosiglitazone (an oral antidiabetic agent) in hopes that its effect to increase deposition of subcutaneous fat may be able to help. Beyond that there is facial surgery which may include implants or injections.