Hi, Dr. Moyle,

I would value your advice: since being infected, I have developed central obesity, which is ironic and cruel for one who just 2 years ago was lean and muscular. In utter disbelief, I watch this huge, distended stomach protruding. It is true that, with other viral symptoms, I do not exercise beyond walking, but I have a mostly healthy diet (except for the occasional chocolate...comfort food when I feel grotty).

What causes the large stomach and waist? I am treatment naive, have a CD4 count of 800 and a viral load that is usually undetectable, though may blip into a few hundred copies. What remedy is there? My testosterone is within normal and so is free testosterone. My glucose is slightly high, but not by much - does that mean I am not diabetic or should I take an insulin resistance test?

Any advice on what I can do to materially reduce the size of my stomach and waist? I have been thinking of lyposuction, but the thought is revolting and I am hoping that there is another way.

Hoping to hear from you on the possible causes of this problem and remedies.

In the absence of treatments for HIV truncal obsity is uncommon. Indeed it sounds like your immune system is doing a great job at controlling the virus. Certainly it sounds worthwhile to investigate the possibility of diabetes with a glucose tolerance test. You should probably also have tests to rule out Hepatitis co-infections.

The metabolic syndrome...insulin resistance, raised lipids and truncal obesity...is increasingly common and may be contributed to by genetics, diet and a sedentary lifestyle. Liposuction is an extreme option and really only effective for removing 'grabable' subcutaneous fat that could be managed by diet and exercise. I certainly think getting back to your former exercise patterns is the key to this and whilst you may feel fatigued from time to time currently, you may find that being fitter will help you manage the fatigue better.

I hope this provided some starting points Regards Graeme Moyle