Hello, Positive here since 1991. Currently on Crix, combivir and tenofivir. On meds since 1997. Undectable VL and CD4s pretty high between 600 and 800. I am "self diagnosing" here but i believe I am seeing some lipoatrophy. Veiny legs and arms, some butt depletion. Cholestrol counts increased with the Crix, but are stable now. My question is, I would of course do anything to stablize fat loss.. and as such am contemplating changing out some of the pills. Any advice? My doc said she favors switching the PI. Any feeling on replacing the combivir with abacavir and something else?

Certainly switching away from protease inhibitor drugs has not been demonstrated to result in peripheral fat recovery. The focus is therefore on looking at your nucleoside analog backbone. As you rightly point out the AZT component of the Combivir may be a contributor. However, recent data had indicated that a combination of abacavir, 3 TC, and tenofovir was associated with a high rate of treatment failure when given by itself to individuals starting treatment. For the time being, it may be therefore worthwhile avoiding switching to this combination. I would start by talking to a doctor about whether you really have lipoatrophy and then considering other options such as whether rosiglitazone may help (based on the limited short-term trial evidence).

I hope this helps

Graeme Moyle