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Lipodystrophy and WastingLipodystrophy and Wasting
           
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questions on your answers
Jan 8, 2004

Hi

The guy from India said he used two condoms. Someone hiv health care person told me not to use two condoms as the friction may cause a leak. Any truth to that?

I am 3 months on first line of meds, kaletra, viread and emtiva. I have seen you say that link between kaletra and lipo is high; but other doctors on this site say it is not strongly established. Can you tell me your source ?

You had told a guy on here today to switch off a PI- he had said he was on zertit, but never said he was on a PI. Do you cut out a part of his question or make an assumption?

Response from Dr. Moyle

Q: The guy from India said he used two condoms. Someone hiv health care person told me not to use two condoms as the friction may cause a leak. Any truth to that? A: He had sex on two occasions and use one condom one each of those occasions. 1 good one is enough!

Q: I am 3 months on first line of meds, kaletra, viread and emtiva. I have seen you say that link between kaletra and lipo is high; but other doctors on this site say it is not strongly established. Can you tell me your source ? A: The sources are both direct and indirect. Keletra is certainly, from comparative clinical trials evidence vs. nelfinavir and boosted saquinavir, the worst antiretroviral (beyond ritonavir alone) for raising triglycerides and cholesterol. Raised triglycerides have been linked in several studies to future risk of lipodystrophy and to severity of lipoatrophy. In the substudy of ACTG384, nelfinavir, a PI closely related to Kaletra, was independently associated with faster fat loss relatively to the NNRTI efavirenz. It is 'generally accepted' that this means all PIs (except perhaps atazanavir which is of a slightly different design) are riskier for fat loss (and fat gain) than NNRTIs. You NRTI backbone however is one of the lowest risk backbones and NRTI choice probably contributes more to fat loss.

Q: You had told a guy on here today to switch off a PI- he had said he was on zertit, but never said he was on a PI. Do you cut out a part of his question or make an assumption?

A:I assumed he may be on a PI...I was anticipating his next question!

Regards Graeme Moyle


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