This is a sticky wicket. I am a 40-year-old female, been successful, healthy, and fit on treatment with Viracept and Combivir since 2000. Great combination for me: been undetectable, good CD4 count (500-700).

I started a nutrition program last year that caused me to lose weight (which really wasn't my aim), but after 6 months my very muscular arms started becoming markedly thin. Still very muscular, but all fat gone, and now I'm thin with what would appear to be extremity wasting. Also, over the last 3 months, the veins in my lower arms and hands bulge very prominently when I get warm or am out in the heat. I work out with heavy weights daily (fitness nut) run, do yoga, all the things I should be doing. I'm now attempting to increase my weight, and my doctor and I switched my regimen to Truvada and Isentress, hoping to stave off further loss.

My burning questions are:

1. Is any of this symptomatology reversible with the withdrawal of the protease inhibitor from my regimen? 2. Will gaining some weight over my entire frame lessen the appearance of the bulging veins in my arms? 3. Could the vein prominence be due more to the low body fat and high muscle percentage/heavy workouts than the medication effects?

Any insights would be SO appreciated!

The AZT in Combivir is the drug your are taking that is most linked to fat loss in extremities so a switch from Combivir to Truvada or Epzicom (if HLA B5701 negative) is very much worth discussing with your provider. Viracept has not been used as much lately in US so data on its contribution to fat loss has been limited. If you have no viral resistance then a switch from nelfinavir to raltegravir, an NNRTI (such as nevirapine or efavairenz), or to a boosted PI may be considered as well but might be expected to have less effect on the fat loss then switching off the Combivir. Loss of extremity fat can cause the veins to be prominent. KH