Hi. I'm a 45 year old male, positive for about 11 years. Have been on an effective salvage regimine for 3+ years of Kaletra, Epivir, Ziagin, and Viread. Labs are normal (liver function and cholesteral level), T-cells 1,000+, undetectable viral load.

Here's my question. Over the past several years, I have developed a serious case of sebaceous hyperplasia affecting primarily the "T zone" of my face. It is very noticable, and although insurance companies deem treatment to be "cosmetic", I believe that treatment is absolutely necessary. I have been given the option by dermatologist of burning the lesions off using laser, or taking Acutane. The Acutane would be dosed at a relatively low level until the problem reduces, then I would begin a maintenance level at a lower dose. The laser therapy does not seem a good choice because they are burned off one-by-one, and they likely would just come back. Problem is I was advised by the dermatologist that there may be a problem with prescribing Acutane to someone on HAART therapy, particularly a protease inhibitor, because of the effect the drug may have on one's cholesteral level. I would really like to begin treatment with Acutane as soon as possible (I'm currently treating my condition with daily topical applications of Retin-A, but it's not working well), and intend to run the question by my HIV physician asap, but thought I'd get your opinion. Can Acutane be safely prescribed to someone on a protease inhibitor HAART regimine?

There usually is not much of a direct drug interaction issue between Accutane and protease inhibitors such as Kaletra. If your triglycerides are already high from the PIs then Accutane could aggravate that and trigger pancreatitis. I assume that systemic antibiotics and/or topical clindamycin has been tried already? KH