Dear Doctor:

My problem is weight loss. I am on the following meds: Trizivir, Metoprolol, Lipitor, Oxandrin (20mg daily), Neurontin, & Clonazepam. Good numbers - 485 cd4's & ND VL. Was diagnosed in 1/2001 and have been undetectable since beginning Trizivir. Had Triple Bypass surgery in November('02) and am recovering well.

I am losing (and have already lost) a lot of fat in my face. I am finding it more and more difficult to keep my body weight up, even on the oxandrin. I have to eat for three people to maintain my weight, and when I don't eat tremendous amounts of food, my weight drops immediately. I feel okay, otherwise, and don't know what to do. My doctor doesn't have any answers. I sometimes have shaking and trembling that usually goes away when I eat. My thyroid is okay, and my blood sugar is supposedly okay too.

Doctor, I'm worried because even with good numbers, I don't look healthy or well. I've never had an opportunistic infection & my baseline VL was 149,000/CD4 170. Any suggestions or ideas about my weight problem? Many people are telling me that I look "sick," and they're right of course. What reasonable step(s) could I take to keep my weight up without bursting my stomach in the process. My recent labs show no infections in my body. Could the oxandrin be changing my metabolism and actually be causing me to lose weight instead of gaining it? This process started before my heart surgery and I don't believe it is, in any way, related to the surgery itself. It appears to be something else. Any ideas or opinions would be welcome. Thanks for your help.

As you will read in the oxandrin insert it should not be used in persons with established heart disease. Additionally, anabolics like oxandrin tend to make fat loss worse by sacrificing fat for muscle...your weight may go up but the appearance may not be helped. They also work in the opposite way to lipitor....anabolics make blood fats worse. Growth hormone should also be avoided in heart disease.

Certainly it is worth looking for infections and having a full endocrine (hormone) screen for thyroid, sex hormones (these will be low due to oxandrin, recheck after you have been off for > 6 weeks), cortisol and insulin (or glucose tolerance). I trust you cardiologist has checked that all is working well in that department. Although Trizivir is thought to be low risk for fat loss some doctors believe AZT could contribute to fat loss...you could talk yo your Doctor about changing around your combination. This would however mean more pills but you could consider a change to a once a day regimen to keep things simple. Unfortunately there are few appetite stimulants that are ideal but dronabinol and megace are both worth discussing. Probably dronabinol is the best starting point. Appetite stimulants should be used in conjunction with dietary advice to make sure you are getting the right amount of calories in without taking the wrong stuff for your heart.

I hope this helps

Best Wishes

Graeme