Licking Lipo : Ready, Set, Switch? - by Derek Thaczuk

POZ - Health, Life and HIV
Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:
POZ Focus

Back to home » HIV 101 » POZ Focus » Licking Lipo

Table of Contents

 
Licking Lipo

Body Language

The Med Connection

Ready, Set, Switch?

Lipo Fix-Its


What You're Talking About
It's Time for a TV Dramedy Series About Life With HIV (22 comments)

AHF Campaigns Against PrEP as a 'Public Health Intervention' (10 comments)

Partial Disclosure (blog) (8 comments)

True Story - An essay by a gay journalist and author who is tired of living in fear of HIV (8 comments)

Health Care is a Human Right (7 comments)

The WHO's Unwise Recommendation for Gay Men (blog) (7 comments)
Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


emailprint

Ready, Set, Switch?

by Derek Thaczuk

There’s no need to take lipo lying down!

Derek Thaczuk listens in while doctors and HIV patients put the latest lipo research to work (differently) on their treatment plans

So your viral load’s undetectable and your CD4s are high, but  lately a thinning face looks back at you from the mirror. Or maybe your lipid levels have you worried about heart attacks—like someone twice your age. What to do? If the boat’s not sinking, should you rock it? Is it best to count your blessings and leave well enough alone?

Not necessarily, say experts—doctors and HIVers alike. “If you have concerns about lipo, you should discuss them with your doctor,” according to Paul Sax, MD, of Brigham and Women’s Hospital in Boston. “We’re all after the same thing, and that’s choosing the best HIV treatment regimen. ‘Best’ doesn’t just mean potent enough virologically—it means least toxic, too.”

Switching off meds, even if they’re known to have lipo risks, may be counterintuitive for some, given the importance of taking HIV medication on time, every day, as directed to avoid drug resistance. But, according to Dr. Sax, “As long as your viral load is suppressed, and the new drug is going to be effective, swapping isn’t going to cause drug resistance.”

A change for the better
Of course, all meds are not created equal when it comes to lipo—and several are stepping way out in front lately. Studies show that ditching Zerit (d4T) for Ziagen (abacavir) can help halt or even reverse facial thinning, and earlier this year, British researchers proved Viread (tenofovir) to be as attractive an alternative. In Graeme Moyle’s Randomised Abacavir Viread Evaluation (RAVE) study, patients on Retrovir (AZT) or Zerit were randomly switched to either Ziagen or Viread. After 48 weeks, both groups had regained similar amounts of fat in their limbs and cheeks. The researchers found that facial gains were “similar to the effect observed [with] a standard collagen treatment.”

A switch may also do the trick for knocking down cholesterol levels. Many protease inhibitors can boost lipids (fats) to heart-harmful levels in the bloodstream. In the Switch Atazanavir (SWAN) study, patients on protease inhibitors (PIs) either stayed on the same meds or switched to Reyataz (atazanavir). By 24 weeks, fat and cholesterol levels improved significantly in those who switched to Reyataz. Just as crucially, HIV remained in check—in fact, viral loads remained suppressed longer in the group that switched.  

When doc’s not onboard
If you find the science encouraging, you’re not alone—but you’ll need your doctor onboard to take it from there.  For patients who are eager to make adjustments to their treatment regimen but find that their health care provider is not budging, try this: Ask for an explanation—and address each concern. But also try figuring out what it will take for your doctor to feel comfortable with a switch: More careful monitoring? A statement releasing him or her from liability? For some HIVers, of course, it may simply be time to find a new doctor—one whom you “interview” about treatment philosophy first.

Judith Currier, MD, of the UCLA CARE Center, believes that when switching meds, “Caution is healthy,” and that, of course, it’s flat-out unwise to jump to a drug you might be resistant to or that could lead to adherence problems. “But if it represents an improvement to your therapy, then it’s something that should be discussed.”


Strategy No. 1
Brian DiCrocco got implants and switched meds, too

Brian DiCrocco, a 37-year-old community activist who lives in San Francisco, feels he’s largely won his fight with lipo. When he quit his first regimen—Zerit,  Epivir (3TC) and Viracept (nelfinavir)—in 2002 for the single-pill, triple-nuke option of Trizivir (abacavir + AZT +3TC), it wasn’t just because of Vira-cept’s gut-loosening effects. “I was starting to really notice some hollowing in my cheeks,” he recalls. “You try so hard to adhere to your meds. And then when you see the looks, sometimes you can’t help thinking, ‘Why am I trying?’ ”

DiCrocco’s face continued to thin for about a year after the med switch; in fact, for Brian, it was Sculptra facial filler (see “Lipo Fix-Its,” page 8) that really turned the tide. “I can’t say enough good things about it.” But his facial implants had a supporting cast: “I’m sure that if I hadn’t switched the meds, things would not have improved so much. I look 100% better and don’t feel like I’m fighting a losing battle any more.”

Strategy No. 2
Derek Thaczuk found that refining his combo was enough
“About two years ago, I had to make a very quick decision about whether to swap Zerit for Viread. Hesitating could’ve meant losing insurance coverage. My face was getting gaunt; an inquisitive aunt was asking awkward questions. But because my history is thick with drug resistance—I’ve been positive since 1992—I counted myself lucky to have an undetectable viral load. (It had taken a three-year pileup of Epivir, Zerit, Videx [ddI], Kaletra [lopinavir + ritonavir] and Sustiva [efavirenz] to get me there.) So my primary care doc, my HIV specialist and I put our heads together. They were satisfied that my resistance profile held no red flags for Viread. And I was willing to trade the devil I knew for the devil I didn’t—as long as my viral load wasn’t at stake. I’m happy to say that it all paid off. My HIV’s still suppressed, and my aunt is finally raising eyebrows about my haircuts instead of my sunken cheeks.”

Hard Questions
Q: Why would anyone want to take HIV meds if it means running the risk of lipo?

A: Because untreated AIDS is still a deadly disease. “If I were really blunt, I’d say: ‘If you’re afraid of how you might look on meds, you should see what you could look like without them,’ ” says Brian Cornelson, MD, staff physician at Toronto’s St. Michael’s Hospital. “Of course, I don’t really word it that brutally, but the fact is, we’re still dealing with a very serious illness.” Judith Currier, MD, expects med fears to drop when the prevalence of lipo itself drops—which she figures will come with greater reliance on low-lipo drugs.

Q: Why would you stick with a drug that’s distorting your body?

A: Maybe because you’re glad to be alive—and because there’s only so much you can switch or fix. Take Elizabeth Perez, 52, from New Jersey. A swollen trunk and severe “chicken legs” haven’t swayed her off antiretrovirals. A surgeon removed four pounds of lipo from her back last year, but she has endured the rest for reasons that haven’t much changed. “I don’t want to look like this,” she says, “but then I think of all the people we lost in the ’80s, who never got a chance at the medications we have now. I don’t think this would be a tough decision for them.”



[ Go to top ]

Join POZ Facebook Twitter Google+ MySpace YouTube Tumblr Flickr
Quick Links
Current Issue

HIV Testing
Safer Sex
Find a Date
Newly Diagnosed
HIV 101
Disclosing Your Status
Starting Treatment
Help Paying for Meds
Search for the Cure
POZ Stories
POZ Opinion
POZ Exclusives
Read the Blogs
Visit the Forums
Job Listings
Events Calendar


    dversescott
    Baltimore
    Maryland


    july8th69
    brooklyn
    New York


    latinpozdallas
    Dallas
    Texas


    RayOctober
    Richmond
    Virginia
Click here to join POZ Personals!
Ask POZ Pharmacist

Talk to Us
Poll
Survey
Pop Watch

more surveys
Contact Us
We welcome your comments!
[ about Smart + Strong | about POZ | POZ advisory board | partner links | advertising policy | advertise/contact us | site map]
© 2014 Smart + Strong. All Rights Reserved. Terms of use and Your privacy.
Smart + Strong® is a registered trademark of CDM Publishing, LLC.