Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date. I've been on Viramune and Combivir for the past 7 years and doing well virologically. But I've noticed in the past year that I have no "butt" anymore and all the fat has gone from my arms, legs, face and buttocks. From my readings I suspect that fat loss is being caused by the Combivir. Are there other NRTI's that I could switch to that would not cause such a pronounced fat loss?
I had heard that swithcing to Viread might help this. Could you please elaborate on this. Thank you.
Mark H. Katz, M.D.
Regional HIV/AIDS Physician Coordinator
Kaiser Permanente of Southern California
Your concerns are well-founded; we do know that increasingly long duration of use of antiretroviral therapies may be associated with so-called lipoatrophy, or fat loss. The area you describe in yourself are indeed the classical areas for this. And, certain of the NRTIs, especially d4T, AZT and ddI have been imputed in doing this more than do 3TC, tenofovir, or abacavir.
Thus, your thought to switch off from the Combivir is a good one.
Also, please note that if your cheeks are especially sunken, there is an FDA-approved substance, Sculptra, which can be instilled into the affected areas to give a quicker result than if you were to just switch medications.
Please discuss all of this with your provider; any HIV specialty provider nowadays has seen this situation multiple times, and can help you overcome it, too!
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