The perils of progress.

A case study is presented of a 49-year-old woman, Molly B., diagnosed with HIV in 1990. Her treatment history is briefly described. Although she has been a part of several clinical trials, her viral load has been below 40 copies/ml since she began a regimen of Indinavir plus d4T plus Nevirapine in 1997. However, the development of buffalo hump and pronounced masculine features causes her great concern. Her case is reviewed by Deborah Cotton, MD, MPH, and Keith Henry, MD. Dr. Cotton recommends switching Molly B. to a new PI and monitoring her cholesterol and triglycerides. Dr. Henry would check for any metabolic disorders and discuss with Molly B. the possibility of interrupting therapy for several months.