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Lipodystrophy and WastingLipodystrophy and Wasting
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Feb 10, 2001

You had a question from a reader on Jan. 2 about getting liposuction for fat around the stomach. You said that a lot of the fat could be "in the abdominal cavity" and liposuction wouldn't help with that. That is the FIRST time I have ever seen anyone clarify the distinction between "surface" fat and "abdominal cavity" fat. I dare say that most of us who do suffer from the effects of Lipodystrophy don't understand the difference, and our doctors never have explained it to us. I had Liposuction 2 years BEFORE I was diagnosed positive (around 3 years ago). I now have lipodystrophy (I was on epivir, zerit, and viracept for 2 1/2 years before switching to sustiva and combivir). At any rate, could you explain the distinction a little bit more? Could this "internal" fat be the reason I seen to have difficultly breathing - especially after eating, and even then eating far less than I used to? My regimen has not changed in the last 9 years (positive for the last 3 1/2) - doing heavy weight lifting 5 days a week and running 3 days (12 miles) a week. The lipodystrophy occurred regardless. And I watch what I eat like a maniac. Maybe it would have been worse without that regimen, but going from a waist size of 30 to 35 is depressing enough. Maybe I should be happy just to be alive, but most days I don't feel like it anymore. Seems like nothing I do has stopped the body appearance from changing drastically. I guess that's just the medications talking, but could you at least talk a little bit more about the fat redistribution in the "stomach" area. thanks.

Response from Dr. Dieterich

There are two ways to visualize the fat in the subcutaneous tissue and in the abdomen. CT Scan is easiest to picture and it only takes one slice. Most people gain weight by putting on subcuteaneous fat (pinch and inch or more). However if you have lipoatrophy, the fat goes inside the abdomen and this is very clear on the CT scan. That is why you probably can't pinch an inch and still have a large waist line! DTD

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