We have a patient who decided to begin meds on 3/7/04 when his CD4 was 154 and viral load >190,000. He was started on combivir and efavirenz, but developed a reaction to efavirenz so was switched to lopinavir/ritonavir on 4/7. He's now saying that he can see facial wasting and being on meds is impacting his quality of life. Any suggestions on different regimens or ...? Thanks.

The development of fat loss over one month of therapy is unlikely. Most likely is some weight loss secondary to AZT and Kaletra related nausea. This will settle and weight should recover. On average, weight and limb fat increase during the first 24-36 weeks of treatment. The initial management step is support and reassureance together with dietary assessment and advice.

This being said a thymidine analog plus a PI represents a riskier regimen for fat loss over time. Certainly it would be worth considering moving away from AZT to abacavir or tenofovir once the patient has settled on their current therapy and consider replacing the Kaletra with the more lipid friendly and easier to take atazanavir/ritonavir.

I hope this helps

Kind regards

Graeme Moyle