Hi Dr Young:

Like that other guy who wrote today,I bug you a lot. Now I am worried because I found out kaletra causes fat accummulation, etc. My doctor never told me that!! I have been on it (along with Viread and Emtiva) for 5 days. I am supposed to on Kaletra long enough to get my vl down. Do you think I could develop lip on that period of time? How long of a period of time wil that be (on average). My vl was about 185K on last test. With cd4 down to 250,

No bugging noted--

I'm not sure where you're getting your information about lopinavir/ritonavir and lipodystrophy, but the essential thing to note (despite the rather incorrect wording in the FDA-mandated package insert)is that there are multiple risk factors for having lipo. In actuality, the additional risk imposed by protease inhibitors is not great and in my view significantly outweighed by the risk of waiting too long to start on therapy.

As for the evidence- there is very little lipo in the most lengthy clinical trials of Kaletra in therapy naive persons (now out to 5 years).

So, I'd worry more about adherence, and avoidance of drug resistance. Lipo is pretty unusual to see in the short term, after starting therapy, whether protease inhibitor based or not.

By the way, there is accumulatiing evidence that injury to the cell's mitochondria can increase the risk of lipoatrophy (fat thinning). Both tenofovir and emtricitabine (Viread/Emtriva) cause very little of this, suggesting that your risk of lipoatrophy should be low, at least from a drug-cause standpoint.

Good luck, BY