I am currently taking Combivir and Sustiva (about 6 weeks). I have noticed some dark patches of skin on my forehead. Do you think the AZT component of Combivir could be causing this? Should I talk to my doctor about switching to Viread? I tolerate both meds pretty well and have seen an improvement in my CD4 count and a drop in viral load. I am frustrated with the condition of my skin. I am black American by the way. Please advise. Thank you.

Hyperpigmentation is a common side effect of a number of antiretroviral medications especially in non-Caucasian people. Although it may be more likely associated with AZT among the medications you are taking, it may also occur with efavirenz. Although it has rarely (if at all) been seen with lamivudine, it has been seen with a closely related drug, Emtriva.

At this stage, I would begin with seeing what your viral load is on these meds. If you have maximal virologic suppression, a single drug substitution of AZT to Viread is feasible. If not, you may consider stopping all your medications (if this is medically safe) and seeing if your hyperpigmentation goes away, to determine if this was truly a side effect of the medications at all. You could consider a whole new regimen in the near future.

Good luck...