Jun 19, 2013
My HIV specialist in NYC tells me I have the worst case of belly fat, neck fat and buffalo hump that he has ever encountered. I am on Norvir, Reyataz and Truvada for decades. Also ran 2 courses of Egrifta with no response. Medicare states that any fat removal surgery would b considered "cosmetic" and therefore not covered. I cannot afford "plastic surgeons". My "BMI" borders on "obese" at 5'6" and 195 lbs. I have tried diet and exercise but cannot seem to get any better. Do you have any other suggestions for me ?
Response from Dr. Henry
Tough situation. Research into treatment for lipodystrophy in setting of treated HIV has dinimished since the rate of development has diminished somewhat with newer drugs (but for sure is still seen and remains a problem) so pipeline for new treatments is unimpressive. If you dont have any drug resistance then switching off the boosted PI regimen to raltegravir or other possibly more fat friendly regimen may be an option. Appeals to medicare have been successful anecdotally (if any reader has personal experience with that please post). I have had patients have reasonably successful surgery for those problems but no one yet on medicare. Diet and exercise often of minimal benefit other than stabilizing the problem. KH
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