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Lipodystrophy and WastingLipodystrophy and Wasting
          
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buffallo hump
Dec 13, 2002

I am thinking liposuction for my buffalo hump and my back. Is there any recomendation of a better way to reduce or eliminate this fat besides liposuction? I already tried diets and excercise.

Response from Ms. Fields-Gardner

The treatments tried for this dorsocervical fat pad (referred to as buffalo hump) have included liposuction and growth hormone. In addition, antiretroviral switches have been maintained as an option. You can take a look at the review from March of this year through the link here:

Review on Identification and Management of Fat Redistribution

While not studied specific to buffalo hump, metformin (an oral antidiabetic drug) has shown some effect in reducing visceral fat accumulation. In addition, a recently published study suggested a relationship between low HDL cholesterol levels and fat accumulations (persons with buffalo humps had a mean of 30.4 mg/dl while the control group of HIV+ patients had a mean HDL of 41.9) and showed an improvement in visceral fat accumulation with the use of niacin therapy (caution should be taken with this type of therapy... don't self-medicate).

[Citation: Fessel WJ, Follansbee SE, REgo J. High density lipoportein cholesterol is low in HIV-infected patients with lipodystrophic fat expansions: implications for pathogenesis of fat redistribution. AIDS. 2002;16(13):1785-1789.]

If the relationship between HDL and fat accumulation holds up, then efforts to improve these levels may be an important part of treatment strategies. Thus other therapies may come into play, such as rosiglitazone (an oral antidiabetic medication that has been suggested to improve blood lipid profiles) and exercise.

Rosiglitazone Study Recruiting to Improve Blood Lipids

Allow me to take a moment to emphasize exercise. While you have tried it, perhaps it is worth keeping it in the picture. A review of exercise research in HIV disease suggested that aerobic style exercise was effective in significantly increasing HDL cholesterol.

[Citation: Nixon S, O'Brien K, Glazier RH, Tynan AM. Aerobic exercise interventions for adults living with HIV/AIDS (Cochrane Review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software.]

All that said, whatever you and your health care team decide on for relief of the dorsocervical fat pad, it is possible that you will need to include exercise, good diet in the long-term sense along with intermittent hormonal modulation. Think "combination therapy" here. Best wishes!


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