Doctors, I am very seriously wanting to have something done to correct the "moon-face" lipodystrophy which I have as a result of ART. However, so far it hasn't been easy to get information. Its clear to me that I'm not the only one with the problem ... I see it often enough. Is there anything that can be done ... cosmetic surgery, drug therapy modification, etc. In the past, I was taking Zerit but have not taken it for about a year, and the problem has corrected somewhat. Exercise has also helped, but so far nothing has made any substantial change. The problem is stable ... that is, it isn't getting worse, but at this point I'm completely exasperated and really want to do something. Could you offer some advice. Thanks.

Removal of cheek fat is more difficult surgically than 'filling' lost fat. Removal of neck fat somewhat easier. In general, however, as you have seen, weight loss through regular exercise and careful attention to your diet often provide benefits without the expense and risks of surgery. I think, if it is feasible, other things that may help would be changing away from protease inhibitors or from your current PI to atazanavir and having a glucose tolerance test and fasting insulin to assess if you have some insulin resistance, if so metformin (see Hadigan JAMA. 2000;284:472-477) would be option. Regards Graeme Moyle