May 30, 2001
I have been pos for 10 yrs w/ no real problems. T cell at about 375 - 400 and v-load at 12000. About 6 mnths ago I decided to start drug therapy even though I had never had any great problems. I am on Zerit, Ziagen, and Epivir. During this 6 mnths I have gained about 40 lbs and am having a horrible time with bloating. My stomach bloats and becomes very hard especially the muscle area below the rib cage. This bloating is constant and does not go down, but does get worse most of the time after I eat and after taking the medication doses.I have had blood workups, ct scan, gastric emptying test, full uper GI workup and all have come back showing no problems. My docter tells me that it is not lipodystrophy because he does not see signs of fat redistribution such as loss of fat in the face, etc.I have read that many people seem to be having this problem. Is there anything that can be done to help? Is there any additional medication(s) that can lessen the bloating and stop and maybe even reduce the weight gain (working out and a strict diet has not stopped it)? I'm still gaining weight and still bloating. ABOUT TO EXPLODE - DALLAS! PS Are there any trial studies for this problem and if so where do I find them?
Response from Dr. Boyle
If you are accumulating fat in your abdomen, this is one form of the fat redistribution syndrome. The first step to consider, given that you did not have the problem before starting antiretroviral therapy and you started that therapy with relatively high Tcells and low viral load (the DHHS guidelines now suggest starting when the Tcells are 200-350 and the viral load is >55,000), is stopping or changing the antiretrovirals that you are on. Second, it sounds like you have had a very thorough GI evaluation, but if bloating is the main problem you might consider trying an agent that stimulates gastric motility (e.g., Reglan) and taking small, frequent meals that may limit the problem. Finally, treatments for fat accumulation are not well settled, although discontinuation of antiretroviral therapy, exercise, diet, growth hormone, and some other agents have all been associated with varying levels of success. There are several clinical trials underway to evaluate treatments for fat redistribution syndrome and you should ask your doctor about studies that may be available in your area.
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