My wife was detected HIV positive 11 years ago after a blood transfusion, and inmediately she began her treatment. Since three years ago she is taking a combination of Viramune (Nevirapine), Videx and Zerit; when she started that combination she had moderated lipodystrophy, but now (VL<50, CD4 >500) she has severe lipodystrophy and moderate lipoatrophy. Then, I have several questions? 1.It's time to switch to another combination? Which one? 2.Can she expect any fat recover? 3. Does the use of NewFill have side effects? Thanks in advance. Zach - Colombia (South America)

Dear Zach, I will take each question in turn.

1.It's time to switch to another combination? Which one?

The combination your wife started on was a popular one a few years ago that has now fallen from favour in part because the combination of d4T and ddI are associated with a higher relative risk of a range of side-effects including fat loss. The simplest combinations for her to change to would-be abacavir plus 3TC or tenofovir plus 3TC (FTC may be also used as an alternative to 3TC). Given that she is tolerating nevirapine I would not change this component of her therapy.

2.Can she expect any fat recover? This change in therapy would allow a gradual recovery in fat but it is likely to take a year or more before you notice any impressive improvements.

3. Does the use of NewFill have side effects? In my experience NewFill is well-tolerated and in the study performed at our centre involving around 30 people there were no side-effects that led people to discontinue the treatment course. The number of treatments one needs with NewFill varies between individuals. Other facial fillers are under investigation for example Bioalcimed is available in Mexico and Holland where anecdotally good responses have also been observed. This product only requires a single injection into the affected area and so may be more cost-effective.

I hope this helps

Best regards

Graeme Moyle