Dear Dr. I am on Intelence+Combivir+Fosamax. CD4 is 190/Undetectable for last 9 months. My weight has gone from 130 lb to 122 lb. Suggestions for increasing my CD4 and weight?? Thank you.

Have you had any symptoms from the fosamax? It can cause burning and upset of the stomach and esophagus. THat could effect your appetite.

If you are male and have symptoms of fatigue loss of libido and erectile dysfunction you should have a free testosterone (hormone) level measured. Low testosterone is fairly common and may cause loss of body mass.

How is your appetite? If it is poor you may need an appetite stimulant such as periactin (cyproheptdine) or marinol, or megace (short-term use only).

Another cause for weight loss while on combivir could be lactic acidosis which is build up of lactate in your muscles (like after running a marathon). That can be measured by your doctor.

Also be sure that you have been screened for cancer and other treatable opportunistic infections that might be causing activation of your immune system (that is your body is fighting them off as you recover from HIV and this can cause inflammation that slows the CD4 increase).

Best, Joe