Hello and thanks for the opportunity to ask these questions. In regards to lipoatrophy/dystrophy, will human physiology allow our bodies to recoup the lost/dead/transferred fat deposits back to their original locations (i.e. cheeks/arms/butt/legs) once a viable treatment for lipoatrophy/dystrophy has been found (i.e. uridine)or is it that once these fat deposits are relocated or die they are gone forever? Will our only course going forward be some form of cosmetic surgery? Do these fat cells actually die or do they just shrink in size while fat cells at other locations (i.e. belly, buffalo-hump, neck) increase in size?

We don't know if the fat can fully return if offending agents or situations are stabilized improved. Experience to date suggests that in some cases fat cells have died and that if fat loss has been severe that fat doesn't generally replenish well even if an offending drug has been stopped. Data is too limited so far to know whether potential treatemnts such as uridine supplementation would reverse severe cases. For now the best approach is to try and aggressively monitor and switch off offending drugs if fat loss is noted the earlier the better. Not all patients lose fat on certain drugs (such as AZT or D4T) so the course is variable. Also, non drug factors such as body weight, age, a lower CD4 count, time with HIV and others can impact risk for fat distribution problems. KH