hi there. after a three-year drugs holiday, it is time for me to start meds again. I stopped because of lipoatrophy. At the time, I had been on 3tc, azt and neverapine. I also did a stint on d4t, and, because of this, have the so called "wasted" look.

I am extremely fearful about starting back on medication again. so, here are my questions:

just how reversible is lipoatrophy?

to date, what is the most lipo friendly regime?

my Dr. has suggested Truvada and nevirapine (have taken nevirapine before, cannot tolerate Sustiva)

Also, I have heard that Sustiva or NNRTI's have now become suspect in contributing to lipoatrophy. is this true

thanks

Our understanding of the relationship between specific HIV medications and combinations is evolving. Recent studies do suggest that Kaletra is less likely to cause fat wasting than efavirenz when either was combined with nucleosides (AZT, d4T, tenofovir). Loss of 20% of limb fat or more was rarer with the combination of tenofovir+3TC+Kaletra compared to the other combinations studied. The difference between Kaletra and efavirenz when they were combined with tenofovir+3TC was pretty small (6% vs 12%).

Kaletra can increase triglycerides more than efavirenz.

There are very few data regarding nevirpaine and fat changes.

Some data indicate that fat can return slowly after stopping d4T (or AZT). But, complete recovery after profound fat wasting has not been seen.

If fat wasting is your number one concern after virologic potency then the data, at this point, suggest that Truvada plus Kaletra should be best. Whether Atripla is significantly different is not clear. I would avoid, of course, d4T and AZT.

DW