Hi Dr.

Are the side effects from the powerful drug therapies permanent? That is, lipodistrophy, wasting esp. nausea just something all treated have to deal w/ or is it a matter of informed dialogue between doc and patient along w/ the increased options (new PIs,t-20, TRAIL) that are available? Thank you dearly

Harris

Some side effects, for example nausea, can be transitory and resolve while continuing therapy while others can be quite persistent, such as lipodystrophy. Still, there is some evidence that changing therapies, for example from stavudine (d4T) to abacavir, may help and some of the newer medications may have very low rates of metabolic complications and lipodystrophy. In the GS 903 trial, the regimen of efavirenz, tenofovir and lamivudine had a rate of lipodystrophy of only 1% at the end of 96 weeks of therapy, which is encouraging regarding the likelihood that rates of lipodystrophy can be improved on the regimens we are using today. Also, there is a growing amount of evidence that lipodystrophy and some other complications of therapy are related to the patients T cells when starting therapy and that higher T cells (over 350) when therapy is begun may decrease the risk of the patient encountering these problems. So, a combination of starting relatively early, with the right regimen, may limit the risk of serious complications.