Hi Doctor, About a year ago I went on a combination of Norvir, Combivir, Lexiva, and Viread. I have recently been noticing a worsening of the lypoatrophy in my arms - they seem to be getting progressively skinnier and the veins are really popping out and looking awful. Do you think the Norvir or the AZT in the Combivir is more likely the culprit? Thank you so much for your time and service. Eric

The answer for which drugs in a combination are the major contributor to fat redistribution problems is often unknown or unclear. In your situation I would often switch the AZT to abacavir while continuing the 3TC portion of the Combivir. If no problems with abacavir then the 3TC + abacavir can be dosed as one Epzicom table daily along with your protease inhibitors. Stabilization or improvement in fat loss can be a slow process (6-12 months often needed to notice if any improvement). Tenofovir might also be an alternative to AZT. In some cases I have also used a double boosted protease inhibitor regimen without any nucleosides at all. There is a fair amount of variability from person to person regarding fat-related issues as well as different treatment histories and tolerabilities so the approach has to be flexible and responsive to a particular patient's situation. KH