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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Abdominal pain and new hump
Sep 29, 2003

I have been on Combivir/Kaletra for 3 months now. My CD4 count was initially 23 and is now 67, and my Viral Load was 300,000 and is now 115. I also take Mepron, Zithromax, Wellbutrin, Protonix, Diflucan (for esophageal candidiasis), and Advair. I am concerned that the buffalo hump is so quick to appear, along with the distended lower abdomen. I am thinking Kaletra is the culprit. I am considering a switch to Sustiva but that has its own set of problems or the new PI Atazanavir. Any advice between the two? Is it unusual to have this fat redistribution so quickly or is just because I was diagnosed with such terrible numbers to start with? I would like to say thanks in advance for the wonderful work you do here. I know that the final decision is mine and my HIV Doc but this sight has made it easier to a much better informed patient. Keep up the good work. Scott

Response from Dr. Conway

Thanks for your kind comments about the site.

This is, indeed, quite fast for true lipodystrophy to appear. It usually does not make an appearance until the second year of therapy. This being said, it will occur more often (and perhaps more quickly) in older men with more advanced immune disease, so anything is possible.

I would simply put forward for discussion that the lower abdominal distension could be an acute side effect of your medications (perhaps the Kaletra) rather than true lipodystrophy. The buffalo hump is harder to explain.

In terms of switches in therapy, a number of possibilities present themselves, as there are good data to support the use of both nevirapine and efavirenz in this setting. Theoretically, atazanavir could also work in this setting, but there are no data yet to support its use as "switch" therapy. The studies are only now being done.

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