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Good choice?

Oct 16, 2006

Any reassurance would be helpful. I was taking Combivir(since 98') along with Viread and Sustiva. Last Cd4 count of 485(lowest if has been) and Viral Load of under 50ml/copie(so undectable there). I startd to show early signs of fat loss in my cheeks and want to avoid any further progression so after much study and questions I have switch to "Atripla" since there is some debate that Combivir can lead to fat loss in face. I know it will probably take 2 yrs for anything to show improvement but was that a good choice? Also--should I choose to have filler injections or fat trasplant----which is better? I am concerned of disfigurement from Cosmetic Surgery and living in Louisian I don't know of any VERY GOOD Cosmetic Surgeon so I am very worried. Any insight would be greatly appreciated.

Response from Dr. Frascino


Actually there really isn't any debate about Combivir and lipoatrophy (fat loss). The AZT component in Combivir is a thymidine analogue and it definitely can (although does not always) cause lipoatrophy. Consequently, if this was a concern for you, yes, you made a very reasonable choice in switching to Atripla (efavirenz, emtricitabina and tenofovir, none of which are thymidine analogues).

Regarding treatment of facial lipoatrophy, fat-transplant injections do not last very long. I would advise one of the facial fillers. So far only Sculptra (New Fill) is available and approved in the U.S. I used this product and have been very happy with the results. However, you'll need to find a plastic surgeon in your area who knows how to inject the product correctly in order to get the best results. I suggest you visit The Body's new (well, relatively new) Lipoatrophy Resource Center. It can be accessed on The Body's homepage under Quick Links. I contributed a live podcast to this resource center and there is much useful information to be found there.

Good luck!

Dr. Bob

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