Dear Doc, I am 27 yrs old and have been taking Combivir and Sustiva for 4 months now. I have had no noticible side effects and my counts are doing very well. I am very worried about developing lipodystraphy. I thought that lipo is generally a side effect of the PI class of drugs. Am I in the clear since I take nuke class drugs? If I am not, when and how can detect early symptoms of lipo?

Thank you JJ

Dear JJ,

This combination is a pretty good choice for minimising risk of lipodystrophy.As you say, PIs are higher risk than NNRTIs. AZT/3TC is lower risk than d4T/ddI and probably any d4T based regimen. Being <40 is handy too. If your CD4 is always >200 then risk is further reduced. In the best available study there was on average no fat loss with your combination over 80 weeks. A long follow up in the lipodystrophy world. DEXA scans are the best 'definitive' test but hard to interpret over short periods. One also needs to consider...for you over the next 10 years... the effects of age and gravity on the body on how you and others see your body. Lipodystrophy, like pornography, is one of things you know when you see it. You Doctor may be the best person to monitor this semi-objectively. He should see your body now and watch it evolve over time.

I hope this helps

Graeme Moyle