I have been treating a 22 year old female patient at my office since June of 2007. She is in need of ARV due to her initial CD4 cell count. The patient has been suffering with Bulimia and Anorexia Nervosa since she was 16 years old. I have requested numberous times that she go to treatment for her ED but she states she is too depressed and feels her life is over, so sees no point in getting treatment.

The patient is extremely disturbed at the weight gain caused by her regimen of Truvada and Reyataz. She has gained 20 pounds since beginning treatment. She states that this causes her to binge and purge, and fast more often. I am very worried for her, because the purging and food restriction could interfere with the absorption of the medications. I am thinking of switching her to another PI, probably Prezista but there is scant data on weight gain that is not lipodystrophy.

Any help would be appreciate.

P.S. The patient was not losing weight before she went on ARV therapy. She had been 145 for long before she became HIV+.