Lipodystrophy getting worse on "lipo friendly" treatment
Oct 23, 2005
Hi Dr. Conway,
I am currently on Viramune and Truvada. I have been on this combination for about 1.5 years. Prior to this combo, I was on Viramune and Trizivir and switched to Truvada to remove the AZT from the regimen (to fix the lipodystrophy). When I started Viramune (2.5 years ago), I noticed that I began to collect fat in my torso. Over the past 3 months, I have noticed that I am atrophying in my hands, forearms, knees, calves and ankles. I have been told that the combination that I am on is least likely to cause the atrophy/dystrophy but it is happening. I am wondering what my next steps can be. I would like to suggest the following to my doctor: 1. Retataz and Epzicom My concern with this combo is that I have been on Trizivir in the past (1.5 years ago). Is Epzicom still an option for me? Also, how will I manage my heartburn issue while on Reyataz? Thirdly I was on a PI based regimen back in 1997-1998. Will I need a Norvir boost even though I did not fail the PI regimen? (I am not resistant to any drugs) 2. Treatment Interruption My doctor is not a fan of this. I have been on treatment since 1997 and it has been successful. Currently my T-Cell count is around 1000 and my VL is around 600 (the VL fluxuates every time I get it checked but has never gone over 1000)
Do I have any other options? I would like to address this soon before more damage is done. I have had moderate lipoatrophy since 1998 and do not want it to become severe.
Response from Dr. Conway
You are on a regimen that is clearly not associated with the appearance or progression of lipodystrophy, so I would not want to change your regimen to address this possible complication, especially if it is being successful.
It is possible that your condition will stabilize (and perhaps improve) over the coming months. It is also important to remember that lipodystrophy can occur in the setting of HIV without any treatment at all, so it will be important to keep this in mind.
As far as a treatment interrruption goes, this can be a consideration for you, especially if your lowest ever CD4 count was above 200. Talk about it again with your doctor to make sure you are both happy with how things are proceeding with respect to this decision.
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