Aug 29, 2002
Brian, in your comment re Sustivia/Lypo, you mentioned that all NRTIs are responsible for Lypo- 3tc being the least. Having said that, is it better to be on PIs? Simply put, where does the medical/science community stand with regards to this phenomenon- lypoatrophy and lypodystrophy? Youre a very compassionate manthanks again,
Response from Dr. Boyle
Tough to say. There are some data that indicate that PIs without nucleoside analogues (NAs) are associated with a relatively low rate of lipodystrophy, and there's some data that show the converse to be true, i.e., that NAs without PIs have a relatively low rate of lipodystrophy. There is also data to suggest that the lower your T cells are when you start therapy that the more likely you are to get lipodystrophy; however, lipodystrophy has also been associated with time on ARV therapy. So, it's a difficult decision regarding when and what to start to minimize the risk of developing lipodystrophy. My own belief is that you should start ARV therapy with reasonable T cells (closer to 350 than 200) and with regimens that are relatively unlikely to cause lipodystrophy (non-nucleoside HAART regimens seem best), and then watch for it and take action if it starts to develop (since once it becomes advanced it is very difficult to reverse).
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