First of all let me thank you for being there and providing reliable no nonsense information and being a life line... I live in Canada and I am taking d4T, 3TC and Saquinavir since 1997. My CD4 used to hover around 900 until about 2.5 years ago and have been slowly declining since then (550 now)and my Viral Load is about 4500. My first question is why is this combination of drugs seem to be not common as I don't read about it anywhere? My second question is that although I seem to be tolerating this regimen well I don't like the fat loss from my face, etc (even though it is tolerable) and I am wondering if a) I should switch to another regimen b)take a Structured Treatment Interruption, or c)don't do anything?

I would really appreciate any input...I will see my doctor next week and he does not seem to have any clear idea?

It is always a pleasure to hear from a fellow Canadian.

The regimen you are on was a very popular and rational one in 1997, as a combination of 2 nucleoside analogues with a non-boosted protease inhibitor. You are now (after 8 years, I will remind you...not a bad run for a first regimen!!!) having virologic breakthrough. It is probably time to stop this regimen. If your lowest ever CD4 count was above 350, you could afford to take a drug holiday and be monitored closely to make sure your counts aren't decereasing rapidly. If you have had a lower CD4 count, it is probably a better idea to get a resistance test done and pick a new regimen that will be effective. There will likely be many choices for you, and I would probably advise you to NOT continue on d4T even if it appears to still be effective. This is the agent most associated with the loss of fat that you describe, and you will surely have other choices...