Question

Which combination is least likely to cause lipodystrophy?

1 September 2011. Related: All topics, Side effects.

Do you know which combination or ARVs is least likely to cause lipodystrophy?

I’m about to start meds and can’t decide between Truvada+boosted PI – either atazanavir (Reyataz) or darunavir (Prezista) – or an NNRTI – ie Truvada+ nevirapine (Viramune).

Also, when is Viramune XR going to be available in the UK? I see it has been approved in Europe but can’t find any more info on it.

Answer

Answer: Simon Collins

Luckily, lipodystrophy occurs much less frequently with any of the drugs that are used now. Most of the problems, especially fat loss, are associated with early HIV meds that are not used in the UK now (especially d4T and AZT).

There isn’t good data to suggest a difference in this risk between the three combinations that you suggested. Atazanavir, darunavir and nevirapine are all pretty good for lipids (cholesterol, triglyceride etc.

The once-daily nevirapine (Viramune XR) was approved in the US earlier this year and European approval usually follows within a year.

Even though the original formulation is dosed twice daily, many people switch to using this once-daily after their viral load becomes undetectable. A blood level test can check whether it is okay for you to do this. As this is your first combination, this is likely to be an option for you if once-daily is important.

If you decide to use nevirapine, the first two weeks uses a 200mg once-daily dose for either Viramune or Viramune XR.