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Lipodystrophy and WastingLipodystrophy and Wasting
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Side Effects Seem Unbearable!
Jan 19, 2000

I am a 32 year old HIV+ male who was diagnosed in July 1999. At present I am not on any medication, but monitor my blood counts every 3 months in order to see how things are. After reading many of the posts in this forum, I am terrified to even think about beginning any anti-retroviral therapy. I know it may seem vain and shallow but I think I'd rather die than go through life with a hump on my back or experience facial wasting that makes me look like a refugee from Dachau.

I have had three VL and CD4 tests done since my diagnosis. My first results were very good. VL was 440 and my CD4 was 850 (37%). After three months I had another test which was discouraging. VL was 2260 CD4 was 680 (34.9%). My doctor was concerned so I had another test after a month. The latest test showed VL 1400, CD4 750 (38%). Doc said it looks good and didn't recommend meds. I'll get another blood test in March. My question is this, based on my above counts do you think I can wait a while before thinking about anti-retrovirals? It seems that even if there is some disease progression it will be slow based on my viral load. If I do decide to take meds what combination is LEAST LIKELY to cause lipodystrophy or facial wasting?

Also, reading a forum like this one may give me a skewed picture of the prevelance of these side effects. What percentage of HIV+ people experience serious facial wasting or lipodystrophy? I've heard everywhere from 15%--70%.

Response from Dr. Fisher

1. You definitely can wait. These numbers are quite acceptable to defer treatment. I agree with your doc.

2. Least likely: probably AZT, 3TC and either nevaripine or efavirenz.

3. Serious facial wasting is probably around 10% or less. The 70% figure includes all forms or lipodystrophy and lipid disorders.

Alvan Fisher, M.D.

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