Dear Nelson, Just a general question: is the development of a Buffalo Hump something that it a hold-over from the older generatipn of medications, or is it something that we can get from the newer generation of meds (I am currently on Stocrin and Truvada, and going well). Thanks, Bangkok

We are seeing less incidence of fat build up behind the neck. In my lectures around the country, those that I still meet with this problem usually have other metabolic issues like higher than normal blood sugar and triglycerides, and higher fat content in general. I also think there are some of us who may be genetically predisposed to more metabolic issues and body changes. But in general, once with removed Indinavir, Zert and DDI from the recommended list of HIV medications, the incidence of lipodystrophy has dropped dramatically. But it is still there for some even when taking more "metabolically friendly" medications.

Once the buffalo hump grows, it is very difficult to eliminate unless a surgeon uses ultrasound assisted liposuction. And in some cases, it may return again if the person has not been treated for their metabolic problems.

Nelson