Dr. Daar, thank you for replying to my question regarding switching the nevirapine to kaletra in a combo with Truvada. You provided some good points. You did mention that "if it ain't broke, don't fix it." well, I kinda feel like things are broken. I should have explained that I have severe lipoatrophy from being on combo's, in the past, that have included d4t and azt. Anytime I hear of a drug that is a little more lipo friendly, my ears perk up because, quite frankly, there's not much fat left!

I have read the recent studies favoring kaletra over sustiva in saving fat. But, as I mentioned, I am not sure how similar nevirapine is to sustiva and if it would even make a difference switching.

thank you for all your time.

Thank you for your follow-up email. I do agree that if there is a problem then it may be worth considering a change. Clearly the best data for reversing lipoatrophy is switching D4T and possibly AZT to either abacavir or tenofovir. I am not aware of such data switching sustiva to kaletra. Consequently, once a person has maximized their nucleosides there is little data to guide us. It is also important to note that the reversal of fat loss, even when it does happen is slow.

At this point I would encourage you to discuss these issues with your provider. It would not be unreasonable to think about the change you propose, but you must do it knowing that there are always some risks and the benefits are not defined at this time.

Best, Eric