weight gain protease inhibitors cortisone diet pills


Question:

Two years ago after a month long hospitalization and finding no definitive answer to my symtoms/illness, I was put on a high (60 mg.) dose of coticosteroids (cortisone). Now reduced to 13. Within several months I gained 20 lbs. (that I did NOT need to put on). One year ago I began a tri-therapy of D4T, 3TC, and Crixivan (Indinivir). Steadily my T4 count up (now 521 up from 0) and all my blood results returned to normal. With the tri-therapy I gained another 20 lbs., all of which seems to be fat. My body form has changed completely. My thighs are thinner, my arms are thin, and I have quite a stomach which I've never had before. With dieting I managed to drop 15 lbs. but somehow I can't shed the rest. I want to take a diet pill (then-phen, or is it phen-then) to help get the weight off. I'm seeing a therapist. The weight gain is a serious emotional issue with me. What can you tell me about the unwanted gain, and would taking Phen-Then be ok? My doctors don't seem to be too anxious to perscribe them for me. Please a dvise......


Dr. Gallant's Response:

Getting off the prednisone (gradually) will be the first step in helping you lose some weight. It's pretty unusual to treat an HIV-infected person with long-term steroids (which are immunosuppressive) without a definite diagnosis. The fact that your arms and legs are thin but your belly is bigger suggests that some of your weight gain may be due to the steroids.

Crixivan can sometimes cause abdominal bloating and weight gain. In some cases, the weight gain associated with protease inhibitor therapy simply reflects the fact that you're viral load is lower, you're healthier, and therefore you put on more weight. However, there may also be other factors at work. In some cases changing from Crixivan to another protease inhibitor can help.

Phen-fen, Redux, and other appetite suppressants have become popular lately, but there is growing evidence that they can have rather serious side effects in some patients. I wouldn't recommend that they be used except by people whose obesity severe and compromising health.

You might also want to have your testosterone level checked, since you are gaining weight but losing muscle mass.