I take Combivir + Sustiva. Is is advisable to change this regime to Ziagen + 3TC + Sustiva in order to avoir AZT and try to reverse lipoatrophy and ginecomastia? Thanks.

This is probably not a bad idea although it is not thoroughly studied. The studies that have looked at that reversal of fat loss with thymidine analog switching have predominantly focused on changing d4T to abacavir. However, it is certainly something I now do in individuals who are on Combivirand have never taken d4T. In the future there should be an abacavir plus 3 TC combination pill so your tablet load will finish up being the same or less. Regards the gynaecomastia, it is not clear whether this will improve as a result of switching. Your doctor should check that you don't have any hormonal abnormalities such as a low or high testosterone or a high prolactin. If these are normal and your gynaecomastia is painful he could consider giving you tamoxifen 10 mg once daily for a short period to reduce the pain and size of the breast enlargement. If the gynaecomastia is not painful it is probably better to just wait and see the results over time.

Best wishes

Graeme Moyle