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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Jul 19, 2006

Hi Doctor:

I have been on antivirals for almsot 7 years. For the past almost 3 I have been taking Kaletra+Epzicom and Viread. I workout a lot, don't do drugs, never drink and overall live a healthy lifestyle. I can not stop notcicing the fat around my lower abdomen and into my lower back (like a tire as they say) just keeps getting more depressing. My jeans don't fit my like they used to, my shirts show this huge belly when I wear them, I feel less able to lift up my own body weight when doing chin ups and when I touch the fat it feels hard. The fat juts oout of the sides of my lower back near my waist and wraps around my lower abdomen almost creating a pregnant appearence. I am losing patience because there is nothinbg to do. My weight goes up and up and up but obviously not from the Lean Muscles I am building but because of this tiring UGLY and awful side effect. Am I basically just left to deal with this without being able to do much of anything? I am undetectable and my T cells are 585. Thanks for your help.


Response from Dr. Henry

It has been difficult to pin down the role of certain HIV meds and increase abdominal fat since some studies have found somewhat similar increasesin abdominal fat in persons of the same age/gender but who are not HIV infected. Fat loss has been a more clearly defined hallmark of HIV treatment related fat changes. There does appear to be a subset of persons more susceptible to abdominal fat increases on protease inhibitors. It is unclear to me whether changing the Kaletra to an alternative protease inhibitor (or to a NNRTI such as nevirapine or efavirenz)would improve the fat problem (i.e to Reyataz or Lexiva) though some patients have noted some improvement. Similarly, it is uncertain to me whether changing your NRTI drugs would help. If other family members (parents or siblings) developed increased abdominal fat atroughly the same age then there may be a genetic components. Studies have noted more fat problems in persons as they age, live longer with HIV, and those with lower CD4 nadirs (all features that are not directly drug related). The benefit of various diabetic drugs or testosterone for decreasing abdominal fat is uncertain to questionable so hard to give a firm recommendation. Growth hormone or growth hormone releasing factor are being studied but have to be administered by injections with high cost. Diet and exercise help some patients but many don't clearly benefit from those interventions. Much still needs to be learned about fat metabolism so effective treatment options are unsatisfactory for many/most patients at present. KH


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