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Question on Lipoatrophy
Apr 9, 2004

I was on DDI, Ziagen and 3TC for several years and noticed moderate facial lipoatrophy, but it did not really seem to be getting worse. After a rebound in my viral load my doctor dropped the DDI and left me on the 3TC and Ziagen and added Kaletra and Viread. It looks to me like my lipoatrophy is getting worse again. Is this my own imagination, or does it occur with this combo or perhaps is it more likely to happen when starting a new regime? (I've been on this new regime for 2 months now) CD4=100 and VL 5000 Thanks

Response from Dr. Henry

Lipoatrophy is still poorly understood. Factors other than HIV meds appear to also play an important role. Persons with lower CD4 counts (CD4 nadir) are at higher risk independent of the regimen (CD4= 100 would be considered low). Older patients and sometimes patients who have good CD4 recovery also appear to be at higher risk. Certain nucleosides (such as D4T) may cause the problem at a faster rate. We don't have much info on various combinations of 3 NRTIs not including any of the "D" drugs but I have a clinical sense that we continue to see lipoatrophy though perhaps at a slower rate. Most HIV specialist are pretty knowledgeable about this important subject but no one has the answers because we still have much to learn. Various studies are under way trying to further our information on this subject. KH

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