Last year I switched to a regimen of sustiva, epivir, abacavir from 4 years on d4t, epivir, crixivan because of concerns with lipodystrophy. I've been nondetect on VL and with cd4 counts in the 600-900 range on both regimens and with very good adherence. I find the sustiva though still, after all this time, very tiring. The CNS effects are not severe but I'm mentally and physically slack. I'm also wary of changing regimens because of the resistance issues. Any recommendations?

The symptoms you're experiencing are not very typical of long-term Sustiva (efavirenz) use, but it is possible that it is causing those problems for you. The first step would be to discuss this with your doctor and make sure there is not something else, for example anemia, thyroid disease, hypogonadism or hepatitis, that is causing your symptoms. If you come to the conclusion, however, that it is efavirenz that is causing your symptoms, you might consider a change to nevirapine and you should not have a problem with resistance problems if your current viral load is <50 copies/mL.