new member / Zerit vs new meds & Sculptra

[Guest guest]

Chuck,

You stated that you're on Epzicom, Norvir and Reyataz. Epzicom is a combination of Ziagen (abacavir) and 3TC. It does not contain Zerit. Zerit is a major cause of lipoatrophy, and given the problems you are struggling with, it would be a terrible drug for you to be on.

Allan

> (Among many other meds) I'm on Epzicom (Epivir & Zerit), Norvir and

> Reyataz and I've had loss of fat in my legs, buttocks and face, and

> have put on some odd deposits of fat, like that delightful pubic fat

> pad, a very hard deposit down the center of my (once defined) abs,

> and a lump about the size of half an avocado below the left pec on

> top of the ribcage. Not nearly as bad as others', but still these

> symptoms cause an issue with self-esteem and an unshakable feeling

> of defeat.

> .....

>> 2) Is there a better " cocktail " of meds to be on that wouldn't

> contribute to these symptoms? I can't afford to keep up with

> Sculptra injections indefinitely. Even though my doctor is supposed

> to be one of the best in the country, he doesn't always give the

> best advice (like keeping me on Zerit for several years).

> Alternative med info would be greatly appreciated!

>

> 3) Should I get off the Zerit ASAP, or is it past the point of

> making a difference at my stage of facial wasting? Or, is there an

> average amount of time when the Zerit stops the fat loss after one

> dumps it from their medications?

.....

[Guest guest]

> (Among many other meds) I'm on Epzicom (Epivir & Zerit), Norvir and

> Reyataz and I've had loss of fat in my legs, buttocks and face, and

> have put on some odd deposits of fat, like that delightful pubic fat

> pad, a very hard deposit down the center of my (once defined) abs,

> and a lump about the size of half an avocado below the left pec on

> top of the ribcage. Not nearly as bad as others', but still these

> symptoms cause an issue with self-esteem and an unshakable feeling

> of defeat.

Chuck,

Epzicom doesn't have Zerit (D4T) in it. It has Abacavir (Ziagen) and

Lamivudine (3TC). Neither of those is getting blamed for lipoatrophy.

Neither are Norvir or Reyataz, so far. I'm not sure if Reyataz has

been implicated for abnormal fat accumulation. I will avoid making any

medical pronouncements since I have no medical credentials, I'll leave

that for someone else to comment on.

[Guest guest]

The very first thing you should do is stop taking Zerit (d4T). This can be easily replaced with any number of safer drugs, such as Viread or Ziagen. Why worry about replacing lost fat tissue when you are doing your best to kill it and promote fat abnormalities by taking Zerit? The following table shows the damage caused to fat cells (adipocytes) when using Zerit (d4T) compared to AZT or all other drugs.

Adipocyte mtDNA copies / cell by NRTI exposure

Mitochondria

Reduction

1,586

HIV negative

1,427

-10%

ARV-naïve

1,169

-26%

ARV-experienced (excluding AZT & D4T)

537

-66%

AZT-treated

234

-85%

d4T-treated

Reyataz does not cause fat abnormalities, nor does 3TC. Norvir does interfere with the metabolism of lipids, and as a result, does cause the build-up of fat in odd places. For a Norvir boosting protease therapy, only 50 mg of Norvir is required yet Norvir comes only in 100 mg pills or liquid. It would be better to take 50 mg of Norvir Liquid than a 100 mg pill.

I have also use a single Kaletra tablet, which contains exactly 50 mg of Norvir, and also a larger dose of Reyataz without Norvir - which is what I use now. If you can normalize your blood lipids and cholesterol, you should not experience further odd fat deposits.

While HIV does not cause lipodystrophy, HIV drugs do. There is no reason to take AZT or Zerit (d4T), and Reyataz is the best protease inhibitor.

HIV can cause wasting, which is an entirely different thing and can be easily reversed with anabolic steroids.>> Hello everyone,> > I apologize if this is a long one, but I'm a new member with some > questions. My name is Chuck Becker, I'm 47, I live in Seattle and > I've been HIV+ since 1988.> > I've gone through a lot of the archives and have found them to be > very informative, helpful, sad, uplifting, and even shocking to see > that so many others have the same issues I do with fat > distribution. I'm somewhat hopeful hearing stories about some of > your abilities to cope and strive for a better quality of life as I > do under our circumstances.> > (Among many other meds) I'm on Epzicom (Epivir & Zerit), Norvir and > Reyataz and I've had loss of fat in my legs, buttocks and face, and > have put on some odd deposits of fat, like that delightful pubic fat > pad, a very hard deposit down the center of my (once defined) abs, > and a lump about the size of half an avocado below the left pec on > top of the ribcage. Not nearly as bad as others', but still these > symptoms cause an issue with self-esteem and an unshakable feeling > of defeat.> > I had a consultation with a plastic surgeon who rated my symptoms as > a 4.5 (I'm assuming that meant I'm between stage 4 and stage 5). > I'm also in psychotherapy because of what this is doing to my mental > state, causing depression, frustration and slight social anxiety. > The therapist suggested that I check to see if others feel the way I > do about this, so, even though it's disturbing to see our common > issue on such a large scale, it was reassuring to read through the > archives and see that I am not alone. (Trust me, the thought of > wearing a burqa was becoming increasingly appealing.)> > This Thursday (8/31/06) I will be going in for my first Sculptra > treatment, so I thought this would be a good opportunity to ask a > few questions since I wasn't able to find some answers in the > archives. If they've been answered and you know the archive number, > I don't mind looking it up myself. Hopefully someone has an answer > or two for me. (Feel free to contact me personally if that makes > you more comfortable about such personal issues.)> > 1) I was wondering if there's any way to lose the hard, fatty > deposits in my abdomen and the avocado sized deposit other than > liposuction? (I live on a staggering $850/month, so that isn't even > an option.) Has anyone had success in diet and exercise alone, and > if so, would you mind sharing this information?> > 2) Is there a better "cocktail" of meds to be on that wouldn't > contribute to these symptoms? I can't afford to keep up with > Sculptra injections indefinitely. Even though my doctor is supposed > to be one of the best in the country, he doesn't always give the > best advice (like keeping me on Zerit for several years). > Alternative med info would be greatly appreciated!> > 3) Should I get off the Zerit ASAP, or is it past the point of > making a difference at my stage of facial wasting? Or, is there an > average amount of time when the Zerit stops the fat loss after one > dumps it from their medications?> > 4) This last one is a question about the psychological aspect of > lipo, and this is something you can write to me privately about if > that would make you feel better. I was wondering what it is about > this syndrome that makes one feel so down when looking into the > mirror and seeing this gaunt stranger staring back... is this due to > the HIV stigma, feeling that everyone knows your HIV status, loss of > feeling attractive, or something else? (Those are my reasons, but I > would be interested in hearing more so that I can compare them to > what I'm feeling but am unable to verbalize.)> > Thank you all in advance for any answers, and for those of you who > have really made a difference in how I feel about myself with your > words. I hope this wasn't too long-winded, and also hope to hear > from you soon. Thanks!! Sincerely, Chuck>

[Guest guest]

L-Carnitine transports long-chain fatty acids across the inner mitochondrial membranes in the mitochondria, where they are processed by beta-oxidation to produce biological energy in the form of adenosine triphosphate or ATP.

Taking L-Carnitine, such as the prescription version Carnitor, helps get the maximum use out of the remaining mitochondria.

But L-Carnitine does not prevent mitochondrial damage, nor does it reverse mitochondrial damage.

An example of the importance of L-Carnitine is provided by people who are on dialysis. Because the dialysis filtration removes L-Carnitine from the blood, without taking an L-Carnitine supplement, people on dialysis experience astronomical triglyceride levels and other elevated blood lipids.

If lipodystrophy, as manifested by odd fat deposits, is being caused by mitochondrial depletion then Carnitor is worth trying to see if increase lipid metabolism can solve the problem.

But people without a history of extensive AZT or d4T (zerit) usage are unlikely to benefit from L-Carnitine supplementation. This type of lipodystrophy can also be caused by protease inhibitor use, other than Reyataz.

Using a protease inhibitor, other than Reyataz, sharply down-regulates the PPAR-alpha fat metabolism in the nucleus of fat and liver cells. A drug like Tricor which up-regulates the PPAR-alpha system can reverse this problem. But studies show that Tricor can reverse this problem in some protease inhibitors but not all, especially at higher boosted doses. This is why I think Reyataz (atazanavir) is so clearly superior to other protease inhibitors.

>> > You might also try L-Carnitine, which seems to have helped reduce lipodystrophy for me (it's a supplement).> My doctor prescribed Carnitor specifically for a diagnosis of mitochondrial damage, so NY Medicaid covers it.> I wish I could reduce my Kaletra dose right now, but my phenotype says otherwise.> > BG> >

[Guest guest]

Hello everyone,

First I want to thank everyone who wrote to me on the list and

privately. I appreciate your quick and informative responses!

It was brought to my attention that I'm not on Zerit anyway, so thank

you for bringing that to my attention. I still blame it for the

majority of the wasting because I was on it for so many years.

When I called the doctor today to put a deposit on my Sculptra

treatments, I was able to get them to admit that it is indeed $500 per

session, not the total price of all 4-5 injections I will need as was

my understanding. Of course that's waaaaay out of my budget, so it

won't be happening on Thursday after all. Defeat.

Thank you again for all of your help! It was very generous of

everyone to take the time to answer my questions and offer words of

advice, wisdom and kindness. Sincerely, Chuck