Losing essential assets

Probably you all know that one common side-effect of some anti-HIV drugs is called lipoatrophy. This basically means loss of fat. Perhaps you'd think that that would be a welcome side effect, but sadly it doesn't affect the stomach; in fact a related side effect sometimes called lipohytrophy has the reverse effect: adding fat to the stomach, the breasts and sometimes causing a buffalo hump. Not much is really known about how this occurs, or even which drugs are causing it. But it's becoming clearer that d4T (stavudine) is most to blame, usually after about a year's use.

It is not clear if lipoatrophy has a clinical impact. But for those it affects, it is a real psychological problem. Last year I met with a group of young women at a meeting of the Indonesian Network of Positive Women (IPPI). For several, their biggest complaint was the reduction of the size of their butts (Indonesian women tend to have more attractive rear ends than some of those you see waddling along the streets of the Western world). One of them told me that she had lost her assets.

As I say, there's no obvious solution. However it is clear that people should not be taking d4T for more than 9-12 months. And there are alternatives here. But it's sometimes difficult to get doctors to treat this seriously, and support a change in the drug combination.

Babé