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Treatment for general body fat loss?
Nov 11, 2010

Dear Dr.,

Like many, I have been reading your comments on this wonderful site for years. Having been positive for 15 years now, I am very optimistic about the long-term effectiveness of the current drug regimen as well as those on the horizon. However, again, like many, I am left with the reminders of the early meds...practically no subcutaneous fat in my face, neck, legs and buttocks. I have gone on drug holidays, switched from the guilty drugs to Sustiva, Isentress and Viread, had a face-lift, botox, Sculptra, tried supplements like L-Carnitine and Uridine. Still, when I see photos of myself next to others my age (I'm 56) I still look gaunt, old and sickly. It's devastating. Is there ANYTHING on the horizon for reversing this fat loss or is the general consensus that these cells dead forever? Despondent but grateful for you input.

Response from Dr. Pierone

Hello and thanks for posting.

Switching to newer, less toxic, antiretroviral medications (as you have already done) is a proven means to improve subcutaneous fat loss. Overall body weight gain may improve subcutaneous fat stores, but also would be expected to increase visceral fat levels. In many cases, total body weight gain increases abdominal protuberance and does little to improve subcutaneous fat. There are also attendant negative metabolic effects that develop in conjunction with visceral fat compartment expansion.

Unfortunately there is no supplement or intervention that has been shown to restore subcutaneous fat in the context of HIV-related lipoatrophy.

Facial fillers like Sculptra and Radiesse are available in the United States and clearly do improve facial appearance. They require maintenance with periodic touch-up treatments. Artefill is a permanent filler and may be used off-label for HIV lipoatrophy, but there is no patient assistance program, and it is quite costly.

There is nothing available in the United States or Europe that I am aware of that can be used to restore subcutaneous volume in other body locations. In Mexico and South America, large volume injections of PMMA have been used to restore subcutaneous structure in a variety of areas. PMMA has been used for treatment of the buttocks, the subcutaneous depressions between muscle groups in the arms and legs, vein camouflage, and back of the hands. The results can be quite good, but as you might imagine, body restoration is a daunting challenge.

I wish I had a more encouraging report, sorry.



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