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Combivir and Sustiva vs Atripla

Jun 23, 2009

I was diagnosed with HIV 8 yrs ago at the age of 48 and immediately went on meds. About a year ago, I started to notice that my legs were getting thinner and my belly bigger. I've always been a "big" guy (5'10", 230), but the fat in my gut has redistributed lately to the upper part of my belly. I didn't know if this was a result of aging or the meds, so I asked my Dr. to switch my meds. I changed from Combivir and Sustiva to Atripla. Does Atripla cause weight gain? I really hate how I look now. I have not changed my diet - I eat a healthy diet and try to stay away from fatty foods. All my numbers are great (CD4, VL = 0, chol is 148 etc). I am thinking of going off meds completely. Will this help with my body changes?

Response from Dr. McGowan

Thanks for your question. You are facing a problem that many people are dealing with who have been on meds for several years or more. Some of the earlier treatments (especially with zerit or AZT- combivir/retrovir) were responsible for loss of fat in the limbs (arms and legs) and the cheeks of the face. This is called lipoatrophy. Some of the newer medications in this class (such as tenofovir which is part of Atripla or abacavir which is part of Epzicom) are much less likely to cause lipoatrophy. In fact, many people who switch treatments regain some fat, although this may be much less after 3 years on treatment before the switch.

There has been no link of Atripla and weight gain, other than the weight gain that we often see when someone starts meds and gets their virus supppressed and CD4 count up at the very start of treatment. This is related to getting an out-of-control infection suppressed. That is not the case for you who have been undetectable for years.

It is not clear what the best treatment for fat loss/gain is for people with HIV. The best thing is to try change to meds that are less likely to cause it (such as Atripla). One thing for sure is that stopping treatment all together is definitely not the thing to do, that will just allow the immune imbalance to re-occur and set you back 8 years.


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