I am 48 years old, HIV-positive since at least 1987, and have been very well, thanks to good medicine and a good doctor. My neck size has been increasing over the past few years, and in addition, I have a slight "buffalo hump." I usually believe in the philosophy that less is more, so I haven't been eager to have surgery or to try Serostim because I always believed I could cope with what is essentially a cosmetic problem. However, over the past few months, it seems to have dominated my self-image. My doctor is great, and he and I have discussed the options, but I'm still not sure which - plastic surgery or HGH - would be better. Or is there somehing else I don't know about? As I mentioned, I'm not enthusiastic about either option, especially since I've heard surgery may have to be repeated, and the effects of HGH may wear off after you stop taking it. I'd appreciate any thoughts you have. Thank you for your time and commitment.

Surgery is the more definitive option. As you rightly say, the reported benefits of serostim are good but often transient. The results I have seen from surgical 'debulking' are in fact rather good, although partial recurrence is reported. The operations are generally short and can potentially be done as a day case so it is not such a drama.

I hope this helps

Graeme Moyle