Dear Dr. Conway:

I started my meds 6 months ago, Sustiva and Combivir. So far I am doing great. The only thing I worried about is my nails on my hands especially on both thumbs are getting darker. It's kind of a vertical line from the root to the tips. now my index and middle finger is starting to have one as well. I've read in one of the column on the net that AZT causes this problem that it increases the melanin in your blood stream. Is that true? Can this be overcome with some medication? Please explain this to me why this is happening. I would appreciate it so much if you respond to my question. Thank you so much!

I am not sure if it is through an effect on the melanin, but it is quite clear that AZT is associated with this side effect. This was actually described in the late 1980s, shortly after we began using this drug. If your viral load is undetectable, you might jsut consider changing the AZT to another NRTI (abacavir, tenofovir, didanosine) and the problem will resolve.