I'm 23, weighed 145# before meds and 185# quickly after starting meds. Counts now are undetectable/193. Whether I have what's called "Crix Belly" or I'm just a fat slob, I'm not sure, but my Doc says it's a good thing. Whenever I mention to him that being this chunky depresses me and gives me low self-esteem, and I want to know what kind of diet and exercise program he would recommend that would be healthy for me, he dismisses the subject by telling me that I just might be grateful for this weight some day and that it's the least of my problems. He may be right, but it's probably the one thing that I CAN change, but don't know how. Can you tell me why my doc thinks weight is important?

For so long, those of us who took care of people with HIV infection were unsuccessfully and powerlessly battling devastating wasting and malnutrition. Then along came protease inhibitors and anabolic steroids, and suddenly that didn't seem to be such a problem anymore. I think it's been hard sometimes for doctors with that sort of historical perspective not to just laugh and think, "You think you've got it bad, I remember the bad old days!"

You can't really blame us, but it doesn't change the fact that times are different now, and so are our concerns. People doing well on the new therapies don't just want healthy numbers, they want to look and feel healthy, too.

Part of what may be underly your doctor's seeming nonchalance on this subject is the fact that we don't really know what to do about it. I haven't found that manipulating the diet helps a whole lot when it comes to "Crix-belly." Using lipid lowering durgs helps to bring the serum cholesterol and triglycerides down, but I doubt if it's going to get rid of the fat around your midsection. Anabolic steroids and exercise may help you build muscle, but the fat will probably still be there. In some cases I have switched from Crixivan to other PIs and it has helped.

There are lots of people studing this problem now, so maybe we'll be a little less ignorant soon. Hang in there!

JG