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what's next to deal with lipodystrophy?
Mar 1, 2007

hello i have been HIV+ for 10 years. i have been on viracept and combivir for about 8. i have been undetectable for the whole time and have tcells of 900. i am starting to see more changes in my body the effects of is starting to make me depressed and anxious. do any of my meds cause this problem. should i take a break from them. what happens after 10 years. does your body start breaking down. i've never felt depressed about it up until now. please let me know the truth.

Response from Dr. Pierone

Hello, it is great that your numbers are excellent, but the difficult part of your situation has been the development of cumulative long-term side effects. Lipodystrophy is the term we use for body shape changes and generally comes in two varieties. Lipoatrophy refers to loss of fat, which can give one a gaunt appearance, especially when the face and cheeks are involved. Lipohypertrophy is fat accumulation, usually visceral or intra-abdominal fat.

The Combivir in your regimen is most closely tied in with lipoatrophy (due to AZT mainly) and the Viracept as a protease inhibitor is linked to lipohypertrophy. So the type of lipodystrophy that you have will guide any changes in therapy.

What about stopping therapy? This is not an unreasonable approach since your CD4+ lymphocyte count is so high. The SMART study showed greater risk in stopping therapy versus continuing, but the absolute risk for someone in your situation would be quite low. A treatment interruption would allow you see how your numbers are off therapy and will take some metabolic pressure off and allow lipodystrophy changes to begin to reverse.

Another option would be to switch your regimen, and the nature of the switch would depend on whether you are dealing predominantly with lipoatrophy or lipohypertrophy.

Thanks for posting and best of luck!

Can I switch to Atripla?

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