Fears of future ticker trouble may put atazanavir, Bristol-Myers Squibb’s new once-daily protease inhibitor (PI), on the top of many HIVers’ check-it-out lists. With the current PIs, skyrocketing triglycerides and cholesterol readings are way too common, but in a 48-week study of treatment-naive HIVers in Argentina, blood fats remained normal in those on atazanavir combined with the nukes d4T (Zerit) and 3TC (Epivir). Those given the same nukes with nelfinavir (Viracept) saw quick and sustained jumps in triglycerides, total cholesterol and LDL cholesterol (the bad kind) -- all of which increase the risk for cardiovascular disease. As a nice bonus, only 13 percent of the atazanavir users had diarrhea compared to more than half of those taking nelfinavir. Although not yet approved, atazanavir may soon be available through an expanded-access program.