I had been diagnosed with HIV in Dec. of 2000. My initial Viral Load was at around 170,000 part per ml and my T-cells were at 225. I quickly went On Kaletra, Videx Ec and Ziagen and no have a a VL that is undectable and T-cells at around 500 and climbing.

I can live with this.

I am, however, incredibly afraid of developing wasting symptoms and unsightly fat deposits. Is this inevitable? If I take periodic drug holidays will I be able to stave this off? I have a fairly brilliant and nationally well regarded HIV clinician, he had suggested early on that there might be some drug holidays and changes in my drug therapy - are there drugs that have a lower occurance of wasting and fat deposits?

Thank you for your time.

It sounds like you are in good hands. Your initial regimen and response seem very reasonable. After a period (? 6-12 months) of initial good response to a regimen such as yours, a switch to a simpler regimen that spares the protease class and perhaps has a lower risk for fat problems is often considered. There are a # of switch studies that have been performed or are soon to open to better elucidate the benefits/risks of that strategy. Switching the Kaletra to either an NNRTI (such as Sustiva or Viramune) or to an NNRTI (abacavir) are considerations. Some of the risk factors for fat problems may not be related to the therapy itself but other issues (aging, time with HIV, good immune recovery, genetic factors, etc). your doc's approach sounds good to me. KH