Dear Doctor

I have been on crixivan and combivir now for 5 years. Since beginning therapy my cd4 count has remained in the 350 to 450 range and VL has been undetectable. At first I noticed several body changes including losing fat in my arms, legs and butt. But now I am developing a large abdomen. I lift weights at least 3 times a week and walk once or twice a week but the exercise no longer helps. I was very happy with the results of the meds and am concerned about changing meds but the side effects are beginning to really bother me. I wanted to know what medications I should switch to in order to lower the lipodystrophy. Thanks for your help and suggestions.

If you have only taken this therapy then you have plenty of options available for you to switch. Moving away from a protease inhibitor drug to a NNRTI, I usually choose efavirenz, can result in improvement in the abdominal profile and may slow the rate in which peripheral fat is lost, while maintaining control of your virus. With regards to peripheral fat wasting there is limited information as to what to do for people who are currently on AZT based regimens however it would be worth considering switching the AZT to either abacavir or tenofovir. If you are planning to switches with your doctor my general advice is to make protease inhibitor to NNRTIs switch first then the nucleoside analog switch a month later when you are through any initial side-effects from the first switch. In general, both these switches are well tolerated and you may find yourself on a twice or perhaps even once a daily regimens.

Best wishes

Graeme Moyle