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Quiting/Swtching meds +nutrition/excercise
Mar 18, 2011

Dear Nelson,I have being hiv+ since year 2000. I am 43 y.o. I started to take Trizivir twice a day since 2003. My Cd4 counts has been in the range of 1100 to 1300 per mL (30 t0 40 per cent) and udetectable eversince (below 75 counts), other values in blood have also remained unvariably within "healthy values" evresince. I am currently confronting a sever limb (particularly legs) lipoatrophy. I would like to get some advise on finding out if quiting Trizivir might help to regain muscle mass. I would accompany it with your reccomendations on nutrition/exercise and probably TRT, since a suspect that Testosterone values are low (I will get my results this week). I am serously considering leaving this HIV treatment.... I live in Caracas and the options for alternative treatments are limited here (no Truvada for instance). I see my doctor every 3 months and in my last visit she sugested quit Trizivir 2/day. But the outcoming results will need to be closely monitored "because we dont know". I would like to have your trained opinion on the issue, so I can have a third party reference. I know this might be a major question for any people including yourself. But your opinion, either, would be at least a trained reference. I am a research scientist. And believe me, I am willing to see what happens if I quit this med. Thanks in advance for your answer. TQ.

Response from Mr. Vergel

Hola compatriota

AZT ( part of Trizivir) is linked to fat loss under the skin. It can also have muscle related toxicities. It has been linked to muscle myopathy (weakness.) In vitro and animal studies have found it to be toxic not only to mitochondria (energy factories) belonging to fat but also those in muscle cells.

Here are some references for your country's drug dispensing authorities to help you justify switching to Epzicom (abacavir+epivir) or tenofovir plus epivir (note: remember that you have to take this background with a boosted protease, non nuke or integrase inhibitor):

Abnormal skeletal and cardiac muscle mitochondria induced by zidovudine (AZT) in human muscle in vitro and in an animal model.

Zidovudine induces molecular, biochemical, and ultrastructural changes in rat skeletal muscle mitochondria.

Depletion of muscle mitochondrial DNA in AIDS patients with zidovudine-induced myopathy

Can Carnitine supplements help counteract AZT's toxicity?

Mitochondrial function and DNA improves when people are switched from AZT to abacavr or tenofovir. But is this enough to argue that it is easier to gain lean body mass after getting off AZT? No one has really looked into that. I suspect and speculate that it may be the case. Fat under the skin definitely increases after that switch.

By the way, it is amazing that Truvada is still not available in my country! I wonder if it is Gilead's fault with high pricing or if it is a government issue. But I assume you have tenofovir (Viread), right? Tenofovir access is still a challenge in many countries in 2011.

On nutrition, I found some of my past answers on the subject of eating well:

Sample Day

Mediterranean Diet

Nutrition and Lipodystrophy

For exercise, I like these two links:

Exercise: The Best Therapy for Managing Side Effects

Best Exercise Videos Per Muscle

I hope this helps. Forward this info to your friends in Caracas. Tell them I am looking for volunteers for my non profit to translate this info for my people in Venezuela.


Finasteride (Proscar or Propecia) and Testosterone Replacement

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