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side effects
Nov 30, 2007

am positive and on ARTs but my body structure is changing my breast and belly are enlarging and my legs and arms very thin Please help I look funny.

Response from Dr. Young

Thanks for your post.

It sounds like you may be developing HIV lipodystrophy-- the syndrome of central (breast, abdominal) fat gain and peripheral (facial, arms, legs) fat thinning-- these are not uncommon, and highly undesirable complications.

The causes of this are multiple, but include having long-standing advanced HIV disease (or a very low initial CD4 cell count) and certain HIV medications. There are data that support switching from d4T or AZT-containing regimen to alternative nuke backbones (namely tenofovir or abacavir-containing ones) to reverse the lipoatrophy components. Recent data suggests that efavirenz may cause more lipoatrophy than the boosted protease inhibitor lopinavir (Kaletra). It's not known if switching from efavirenz to lopinavir will have any beneficial effects, or if these effects are generalizable to other NNRTIs and PIs. There are fewer effective treatments for lipoaccumulation; the use of human growth hormone has been shown to improve these symptoms.

Be sure to talk to your doctor about your ongoing symptoms.

Best of luck, BY

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