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Lipodystrophy and WastingLipodystrophy and Wasting
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Lipodystrophy?? Please Help
Jul 12, 2000


I am HIV positive since 1996. I have started therapy with AZT, DDI and Saquinivir. At the end of 98 VL become positive and my doctor changed my meds. I'm on quadruple therapy (Viramune, Viracept, Zerit, Epivir) for 1 1/2 now. 401 Tcells, 23% and VL < 50 (since 24/2/99). So for the past year it seems I have experienced noticable fat loss in the face, arms and legs (it seems to be lypodistrophy). I also have been noticing rapidly increasing visibly protruding of veins in my arms and legs. Because of that I am suffering some pain in my legs. This is very bothersome to me. From what I read, I'm lead to believe that Zerit is most likely the cause. My three questions are: Is it possible to change just one drug in this combination without risking the others (i.e. d4T)? If so, what would be a rational choice? And what do you think about the use of testoterone? And what about a drug holiday? And how long can it be? I have talked to the Doc about this, but the last visit we decided not to change. I realy think he is good, no, I know he is good. I would appreciate another opinion. Thanks for your help.


Response from Dr. Dieterich

You are correct that the zerit is most likely to cause this. You can change just one drug if the viral load is undetectable usually without any problems. A logical choice would be abacavir (Ziagen). Testosterone will help you feel better if it is low. You should have a serum lactate level and if it is elevated an interruption would be OK. Most people stop for a maximum of 2 months, but there really is no data. Some people also think that riboflavin, CoQ, and carnitine will be very helpful in reversing the lactic acidosis. Douglas T. Dieterich, M.D.

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