Dear Dr.

I have been on anti-virals now for almost 2yrs. now.

I have been on the combination of Sustiva, Epivir, and

Zerit for the past 8-9 mos with VL<40 and CD4 of 1100.

In the last 4-5 mos I have noticed my veins popping out of

my skin legs, arms. I'm steadily losing weight everywhere

no matter what I eat. I am 6'1 down to 177 from 190 maybe

6 mos ago. I'm afraid of this trend continuing further!

To complicate matters triglycerides and cholesterol are

elevated. What are your suggestions? Starting to worry.

Thank-You MIKE

This is being reported more frequently even in people not taking protease inhibitors. Aside from the appearance issues we're not sure if the changes are truly significant or not...even the cholesterol/triglyceride elevations.

The smartest thing to do is exercise which will help maintain your muscle mass and should help the cholesterol and triglycerides...we really don't have an answer for the loss of fat that you are experiencing in your limbs. Adding an anabolic agent such as oxandrolone has been shown to further increase weight and muscle mass over that which occurs with exercise. Growth Hormone may be effective for fat accumulation (which you are not describing). Talk to your doctor, see a nutritionist.

Alvan Fisher, M.D.