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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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surgery to remove lipoma vs. other treatments
Jun 8, 2005

Dear Experts, I'm a 39 year old male. I've been HIV+ for 16 years. I just came back from a consultation with a plastic surgeon regarding my buffalo hump. I've had it for 3-5 years, but only in the last 6 months has it grown rapidly (measures 15 cm). It is beginning to give me neck pain and headaches.

I took my recent CT scan images with me. The doctor spent very little time (especially physically) examining me before scheduling me for surgery to remove the fat. This will involve cutting open my skin and scraping the fat from the muscle and having a drain in place for two weeks.

Is this an appropriate and effective treatment? Are there other less-invasive treatment options? Should I get a second opinion? I just want to look half-way normal again.

My HIV doc still has me on protease inhibitors. I've been told that this is the class of drugs most likely to be the cause of my buffalo hump. Should I consider changing my regimen?

Sincerely, Hopefully Hump-free

Response from Dr. Henry

I have had a small number of patients undergo surgical removal of buffalo hump. That procedure did work for them but in some of the cases the hump recurred so that the procedure needed to be repeated. It isn't clear exactly what is the contribution of the protease inhibitors to the fat accumulation versus the other drugs in the regimen. Often a review of your treatment history and consideration of alternative posibly more fat friendly drugs is a reasonable option. Growth hormone, growth hormone releasing factor, exercise/diet, testosterone and other interventions are under study for this problem. KH

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