POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: apple on July 02, 2007, 11:37:23 pm
-
Hi Everbody,
I have got a ten year positive daughter. She has been on kaletra, d4t and ddl from 2004. She has been doing well. Her CD4 count was around 140 or so when she started, now its around 1800. However, the drugs have been affecting her face seriously. She is now all bony, especially in the face. I was sad last week when she told me that she hates her face because it is so bony...
Anyway, her doctor wants to change her to kaletra, ABC and TDF. Do you think this will help? I mean should we expect that her face will become fuller with time? Prior to kaletra, d4t and ddl she was on a combination drug of stavudine, nevirapine and lamivudine.
Your thoughts on this matter will be appreciated.
Worried and concerned mum,
-
Hey honey,
My understanding is that the 'd' drugs are the main cause of the facial lipo. The switch should halt the process. Some research is saying that this can correct itself - but how much and how long is hard to say.
There are some very effective filler injections to correct this - some friends of mine have had this done and look great.
I'm sure she is beautiful.
take care.
-
i would suggest getting off the dt4 which is the main cause of lipo,talk to your doc and consider switching to another combo
-
d4T and ddI together are an undesirable combo (1) because of fat loss (2) increased risk of lactic acidosis.
The switch will help by halting further fat loss, if the drugs are causing this. Over time, but not necessarily quickly, fat will normally return after a switch.
The proposed alternatives, abacavir plus tenofovir are a slightly unusual pairing, but combined with Kaletra appear to give good results (says several studies). Tenofovir dose may need to be adjusted by weight/renal function, this is something to discuss with the doc/pharmacist since recommendations on this are not as clear for children as for adults.
Starting on abacavir it is important to understand the signs of hypersensitivity reaction, something that occurs in perhaps 1 in 20 people using this drug. There is a simple blood test which can more or less rule this in/out as a risk, and your doc should order it before deciding to use abacavir.
Hope this helps
Good luck
- matt
-
Another reason for switching from the d4T and ddI is that each of these drugs can cause peripheral neuropathy (especially d4T).
Unfortunately, it can take years to regain the fat that was lost due to these drugs, and there's no guarantee that it will ever return.
A few health insurance companies cover Sculptra treatments for facial restoration. In the Bay Area, for example, Kaiser covers this procedure. There's also a patient assistance program that can help defray the cost of the Sculptra, but it doesn't cover the fee for administering the injections.
I don't know where you live, but another alternative for facial restoration is PMMA. I had this procedure done in Mexico, and I'm very happy with the results. If you PM me, I'd be glad to share my experience with you.
Allan
-
A switch is indicated in this situation. I wonder why it took that long to contemplate the switch. More surprisingly, I wonder, why that combo was used to begin with. Even prior to 2004, it was already known that the ddI/d4T combo produced more toxicity (including lipoatrophy) than the other NRTI-based combos that were already available.
This is a Q&A from Hopkins by Dr. Gallant back in 2003:
http://qa.hopkins-aids.org/forum/view_question.html?section_id=61&id=75527&category_id=109 (http://qa.hopkins-aids.org/forum/view_question.html?section_id=61&id=75527&category_id=109)
P.S. Is there a reason why 3TC or FTC are not being considered in the NRTI combo? She can potentially go with ABC/3TC + Kaletra or TDF/FTC + Kaletra; there's more data out there on these combos.
-
Thanks guys for the responses! We have had less options because I come from a developing country and there is so little choice with drugs. Currently I live in Japan but the drug prices here are so exorbitant. I therefore get the drugs from home.
Will read the thread, thanks once again.