Dear doc,

Im 33 yo, currently taking sustiva kivexa / epzicom for 14 months now, VL undetactable / CD4 666. I started this treatment trying to avoid lipodystrophy which hit me hard legs, butt and face - in my inicial combo: nelfinavir ddI d4T. I was off meds for 5 years between these two treatments remaining in good health. I saw some very slow improvement in the lipo during the break, however now Im back to square one, it seems Im in that low percentage that also shows lipo with Sustiva, particularly butt and legs. Do you think a switch to Reyataz + Epzicom would help stabilize the lipodystrophy? Would Norvir be also needed in this combo? If I understand correctly Norvir is not as lipo friendly as Reyataz.

Once more thanks for being there and providing this great resource for HIV+ people.

good question-on the outer fringes of where data can guide us. Fcators other than HIV drugs contribute to lipodystrophy issues including genetics (how do you aging relatives look), aging, time with HIV, CD4 nadir and others. Head to head comparisons of efavirenz versus boosted or unboosted atazanavir zeroing in on fat distribution have not generally shown significant differences. A switch to Truvada (if that is available versus Kivexa) is another option as is use of raltegravir if you have no history of drug resistance/virologic failure. My general experience with boosted or unboosted atazanavir with Epzicom (Kivexa) has been good regarding fat distribution concerns. KH