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Lipodystrophy and WastingLipodystrophy and Wasting
           
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High Cholestrol, Buffalo Hump, and Lipodystrophy
Oct 12, 2003

I was diagnosed as HIV+ in 1991. I have been a vegan for over 5 years. I had been on Norvir, Fortovase, Epivir, and Sustiva for ~3 years. Before that, I was on a Crixivan cocktail. About 5-6 years ago, I developed Lipodystrophy and "Buffalo Hump", and high cholestrol (controlled and treated with Gemfibrozil). A month ago, my doctor and I switched my cocktail to Norvir sid 1-100mg, Reyataz sid 2-200mg, Epivir sid 1-300mg, Viread sid 1-300mg, and Sustiva sid 1-600mg. Both the Lipodystrophy and Buffalo Hump are becoming increasingly frustrating from a quality of life standpoint.....especially, since I am Vegan. I have consulted with a dietician to address any dietary habits or deficiencies. I workout ~3 times a week (mostly weight training). I am 42yo, 6'2" tall, and my weight hovers around 230# (38" waist). What steps can I take to eliminate the High Cholestrol, Lipodystrophy, and Buffalo Hump. Thank you for taking the time to answer my question. I appreciate your efforts and caring!

Response from Dr. Moyle

Your doctor has given you good advice with regards to modify your combinations to one which should place the least strain on your fat metabolism, sugar metabolism and fat cells. However, once a syndrome of fat accumulation has established itself modification of medication may not be sufficient to break a vicious cycle. The syndrome of high blood fats and fat accumulation in the abdomen, known in general medicine as the metabolic syndrome, is increasingly common in the general population in part secondary to "over nutrition". It is clear from your comments that this is not the problem, you are doing all the right things. A common accompaniment of the metabolic syndrome is resistance to insulin. The best way to test for this is to perform a two-hour glucose tolerance test together with a fasting insulin. If either of these tests are abnormal it will be reasonable to consider intervening with metformin (starting at 500 mg BD). This has been studied in people with HIV who had insulin resistance and has been shown to help reduce the amount of fat in the abdomen as well as improve some of the fats in the blood, improve blood pressure and some other changes which may be associated with future cardiovascular disease risk. No details on buffalo humps were given in the study but anecdotally they Growth hormone has also been used to reduce abdominal fat, has been reported to reduce the size of buffalo humps and may in improve blood lipids at least during the time it is being administered. These benefits may wear off after stopping.

This should give you a few starting points. The key words are patience and persistence.

Regards

Graeme Moyle


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