Question:

I have been HIV+ for 9 years. I was on combination therapy for the first 6 (3tc, D4t and Viramune). 3 years ago, my doctors suggested that I take a drug holiday, and my viral load remained undetectable until this year. It is now at 18,000 copies, and my CD4 count is around 480. Should I be concerned about my current status?

My current doctor (a new one) has suggested that I start medication therapy again, and has suggested Truvada and Viramune. My concern is that Truvada will case a fat deposit, or "hump" and I'm a working model so my looks are everything. Should I go back to my previous combination? And, is there a way to increase my CD4 count without taking HIV meds at this time? Overall, I am fine physically and mentally. I am just concerned over the numbers.
Your opinion would be much appreciated.

Answer provided by:

Lisa Capaldini, M.D.
Internal Medicine

I think there are two questions here: Should you restart your HIV meds, and if so, which meds would be least liikely to cause body shape changes. As far as the first question goes, I don't see any reason you need to resume HIV treatment UNLESS you are having significant HIV symptoms (weight loss, frequent sweats) or unless you have another condition your HIV might aggrevate (chronic hepatitis C, TB, cancer). As far as the question of WHICH meds, the current thinking is that protease inhibitors are most associated with fat accumulation (lipohypertrophy) and nucleoside inhibitors (especially Zerit) are most associated with fat loss. Thus, the Truvada/Viramune regimen is a good choice although that means you are less likely to get a body change, not that you won't at all.

I bet you will do well whether or not you resume meds now: Good luck with your decision!

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