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hiv meds

Sep 18, 2005

my currents meds are d4t, 3tc, sustiva. cd4 225, cd4 16%, VL undetectable. My problem lipodystrophy, wasting. My DR switched me to combivir & sustiva & no steroids. will this improve my body disfigurement? if no, what can I do? I got infected 1989

Response from Dr. Young

Thanks for your post.

There is a large body of evidence that tells us that d4T (Zerit) is associated with an increase in the risk of lipodystrophy, especially fat thinning (lipoatrophy). Switching to other nucleosides, especially abacavir and tenofovir have been shown to slowly reverse the fat loss. There is lesser data about switching to AZT (as would be your situation, since AZT is half of Combivir) and since AZT can cause lipo in some patients (though at much less risk than d4T) this switch might be less effective that a switch to the other medications in helping your body fat. Be patient, though as even the best nuke switches take months, if not years to see the imnprovement in facial fat.

If need be, there are fillers (Sculptra) that can also be used (plastic surgery, sort of) and are approved by the FDA for use in this indication.

Good luck, BY

Is this OK? What next?
Low VL, high CD4 and KS

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