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Lipoatrophy
May 26, 2007

I have a friend on Stocrin & Aspen Lamzid and she has peripheral lipoatrophy. How can she reverse this condition? Also is this combination of drugs good if she plans to have a child?

Response from Dr. Wohl

Stocrin (also called Sustiva) and Aspen Lamzid (also know as Combivir) have been often combined and this was once the most popular combination of HIV medications in the US.

We do know that fat loss of the limbs does occur with this combination. It is not as frequent or severe a problem as is seen with stavudine (also called Zerit or d4T) containing regimens but worse than some other regimens.

There are data to suggest a change to a more fat-friendly combination can start to reverse lipoatrophy. Of course, whether switching is an option depends on what other medications are available. Recent data suggest that tenofovir is less likely to cause fat wasting. Further, people switching from from stavudine to tenofovir have seen limb fat increase. Other data indicate that the protease inhibitor Kaletra has less effects on limb fat than Stocrin.

So, if available, a switch to tenofovir plus Kaletra plus either amivudine (Epivir) or emtricitabine (FTC) would help give her limb fat a chance to slowly start to return and at least prevent further loss. It is unlikely she will retrun to the level of fat she had years ago.

As far as pregnancy goes there are a few issues. Storcin is absolutely the wrong drug to be on if one wants to become pregnant. It has caused serious birth defects in monkeys and there are reports of some problems in humans. Second, how does she propose to get pregnant? If she has sex with a man who is HIV uninfected she can pass the virus to him. Lastly, she needs to be on a stable and effective HIV regimen to reduce the risk of transmitting her infection to her infant. The decision to become pregnant when HIV infected is complicated and, I hope your friend is well informed and has the support of her doctors.

DW



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