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Lipodystrophy and WastingLipodystrophy and Wasting
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Another d4T/wasting question
Jun 11, 2000

Since being diagnosed in 2/99 (vl.= 51,000, cd4 = 200) I have been on Sustiva, 3Tc and d4T. I am relatively happy with the combination - have remained undetectable and, until recently, have experienced few side effects. Recently, however, I have been noticing rapidly increasing visibly protruding of veins in my arms and legs. I work out often and am able to maintain lean muscle mass, but my limbs are starting to look like a road map. This is very bothersome to me. From what I read, I'm lead to believe that d4T is most likely the culprit (although I don't think you are convinced). My two questions are this: Is it possible to change just one drug in this combination without risking the others (i.e. d4T). It is so bothersome that I'm willing to give it a try. If so, what would be a rational choice? Thanks for your help.

Response from Dr. Fisher

As long as you are undetectable on an ultrasensitive viral load assay (less than 20-50) then we generally think it is OK to switch out one agent in a regimen. You could try to do that with d4t and see what happens. But be might not see anything for several months.

Instead of d4T you could try abacavir or even AZT.

Good luck, let us know what happens if you try this.

Alvan Fisher, M.D.

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