Given my isolation here in Dublin ,Ireland it is great to have your site to go to.Thanks a lot!My situation is as follows:I have been positive since '97 and havehave switched treatment from Ritonavir/Sequinavir+Combivir to Kaletra/Stavudine/3Tc one year ago.I have had a decetable virus twice since I became positive and I am currently undecetable with a CD4 count of 790.My problem is that I am developing a terrible paunch since December 'o2 and am worrying about it affecting my face in the future.I have spoken to my Doctor and she suggested switching to abacavir but staying with Zerit and 3TC.My own research would indicate that it may be Zerit that is the real culprit in the equation.Kaletra is a very powerful drug but I don't know about it's effect on fat redistribution.I want to prevent facial wasting and if possible to reverse the fat around my belly.Any advice you have would be greatly appreciated. Noel,Dublin,Ireland.

Associations between protease inhibitors and fat accumulation in the belly have been described, and fat accumulation may improve if the protease inhibitor is switched to a NNRTI or abacavir. Additionally, diet and exercise should help. In the longer term the duration of therapy, certain genetic characteristics and whether it had a low CD4 count in the past all contribute to the risk of fat loss in the periphery. The risk of this with d4T is greater than AZT and risk may be further reduced with abacavir or tenofovir. You should discuss with your doctor the risks of modifying therapy relative to the benefits

Best Wishes

Graeme