Question:

Dear Doctor:
I have been taking Combivir and Sustiva for about 2 1/2 years now, and have noticed a tremendous amount of weight gain, about 20lbs. Especially in the abdomen. I exercise 3 times a week (30 minutes cardio plus some weight lifting, totaling 1 hour), and have been on Jenny Craig. I REFUSE TO LOOK LIKE AN APPLE! I want to go on Xenical. No appetite suppressants, for I have a mild heart murmur since birth. All blood work is fantastic, except for my LDL which is way too high and now my Dr. wishes to put me on some cholesterol medicine. I've already been taking steps to reduce my cholesterol as well, i.e., eating more fiber, taking Omega-3 Fish Oil, changed my margarine to Benecol, and drinking Minute Maid Heartwise Orange Juice with plant sterols. What do you think about Xenical?? Patiently waiting your response...

P.S. Any news on a cure yet???????

Answer provided by:

Peter Shalit, M.D.
Internal Medicine

I applaud your efforts at exercise and diet. I am not sure Xenical is the answer to your problem. It blocks the absorption of fat, and can cause some weight loss – maybe 5 pounds or so. But if you take Xenical and eat something with fat in it, you can get flatulence (farting), fecal urgency and oily fecal leakage. So taking Xenical might help train you to eat less fat, but there is no proof it will help you lose your 20 lb. Anyway, you can try it if you like, because the active ingredient (Orlistat) has just been approved to be sold without a prescription.

All of this may not change the shape of your belly or lower your LDL much, though. I agree with your doctor about medicine for LDL, because a high LDL puts you at risk of a heart attack or stroke. There are a lot of factors that can raise LDL and increase your waist size: diet, exercise, genetics, age, HIV and the meds that are used to treat it. You might discuss with your doctor whether switching some of your HIV cocktail might improve your LDL. I don't have a great solution for the abdominal weight gain, but there are medicines being studied that may be helpful for this in the future.

Good luck!

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