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Lipoma follow up for Dr. Aberg.
Aug 20, 2002

Dr. Aberg, Thanks as usual for all of you insiteful answers. About a year ago I told you of my being pos. since '86. Have taken most all of the anti-virals. Crixivan REALLY lipoatrified me. Amprenavir worked for a couple of years, but then the Trikes. and cholesterol blew off the charts (700 and 260.) and the DDI gave me really bad neuropathy. So we switched to Viread, Nevirapine and Ziagen. YOU said that Amprenavir could (and in my case really did) make lipomas worse. Well now that I have switched drugs I really notice a proliferation of them forming on my arms and legs. BUT Trikes, Cholesterol and fat on stomach and chest have all diminished. Is there anything to do here? I am taking a vitamin called Bromelain which is supposed to help dissolve them. I noticed that years ago they all disappear with the Crixivan, but alas along with all my other body fat. Lastly, last year after having a double compound fracture accident my docs. said that i have osteopenia (maybe from the Amprenavir and other P.I.s over a long haul.) Now taking weekly Fosamax, but noticed that Viread may be really bad for all of this??? Viral load now nothing and t-cells at around 555. Don't get me wrong though I remember back to the mid 80's when I lived in St. Louis and Dr. P up there and I were seaching for anything that might work like "Dextran Sulfate" and that old "egg derivative" and was really nasty to drink. Really miss the St. Louis food in Houston, but will visit soon. Take care.

Response from Dr. Aberg

I wish I had an answer for you but unfortunatley I do not. Some of my patients have had their lipomas excised (cut out) by surgeons either for cosmetic reasons or because their location was causing them pain.

Osteopenia is a complex problem. It is unclear what meds or if it is the meds that are associated with osteopenia. One study suggests that the osteopenia may even improve on antiretroviral therapy. It is unclear how many of the other traditional risk factors such as smoking, use of prednisone, excessive weight loss versus HIV itself play a role. I am unaware of Viread being more associated with osteopenia compared with other therapies. I think the jury is still out and we need to learn a lot more before any conclusions can be made.

I think I asked this before but I cannot recall. What was your lowest CD4 count? If it was never less than 300, you may want to consider stopping meds if you have access to one of the clinical trials exploring this option.

I will be giving a community talk in Houston soon to discuss the metabolic complications. If you are interested in attending, please call Rich Arenschieldt at the Center for AIDS for more details.

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