to other PIs probably won't confer resistance to atazanavir. Atazanavir is some way off being licensed but is imminently available on expanded release.
This is when to ask if your clinic has a stored sample of your blood on which they could do a resistance test, to find out if you've got 'archived' HIV that is resistant to nukes or PIs, and which may seize its chance to reproduce if you change your regime.
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One study combining the two PIs atazanavir and saquinavir showed falls in triglycerides and to a lesser extent cholesterol.
One option not tried enough is the idea of using the '3rd NNRTI', delavirdine (Rescriptor) to boost PIs, instead of ritonavir. This drug was never licensed in the EU because its three-time-a-day dosing made it a poor third to the other two NNRTIs. It boosts most other PIs in the body (except possibly amprenavir), but without raising lipids. Some studies indicate that twice-a-day delavirdine plus a PI is as effective as ritonavir plus a PI for people who've failed a single-PI regime. Delavirdine has similar side effects to nevirapine, and because it's unlicensed, may be difficult to get.
Diabetes and insulin resistance are often present, and linked to, other signs of both fat loss and fat accumulation. The PI indinavir brought it on particularly fast when HIV negative people were given the drug experimentally. Remember: being female (which you can't do much about) and being obese (which you can) are strongly linked to diabetes.
The nucleoside drugs are firmly implicated here. Many doctors suspect the pain and numbness of neuropathy and the dangerous 'hyper-exhaustion' of lactic acidaemia are both caused by damage to the mitochondria, the energy-processing components of cells. The 'd' drugs - ddC (now not much used due to this toxicity), d4T and ddI are the most toxic to mitochondria, AZT, tenofovir and abacavir the least, with 3TC somewhere in the middle.
A study at Barcelona this year found that people taking a nucleoside 'backbone' of 3TC/AZT were
also less likely to fail virologically than those taking ddI/d4T.
