Dr. Moyle, Help!! I am a 40 year old HIV positive male. I have been positive since 1992. I was put on protease inhibitors in 1995. Since that time I have developed diabetes, hypertension, hyperlipidemia, and cardiac problems. I also have gained the unfortunate belly as well. Is it possible that if I lose weight, the belly will go away or is lipo permanent?Or should I just expect to live with these body changes for life? Thank you for your service to our community. Todd

available evidence would suggest that at least partial reversal can occur although the time it takes to accrue obvious benefit from some interventions is >1 year and probably a lot more. The main considerations in management which you should discusss with your doctor are: can treatment be modified away from PIs and AZT or d4T? can the diabetes management be enhanced?(i.e. metformin may help reduce the belly but people often lose weight, Rosiglitazone is being investigated to improve both central and peripheral fat, insulin may also be useful for weight gain and improving body shape. Note becase of diabetes Growth hormone should not be used and anabolic steroids may make the lipid profile worse). Managing the diabetes well may improve lipids a lot. Can you access advice from a cosmetic surgeon who may use a 'filler' to improve facial appearance?

Best Wishes

Graeme Moyle