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Lipodystrophy and WastingLipodystrophy and Wasting
          
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Fat abdomen - truncal obesity
Apr 16, 2001

Hi. I have been HIV+ for 5 years. Was on HAART for 3 years. During that time, I gained a lot of fat in my abdomen. I have been off HAART for 2 years and my Tcell count is 500+, but the fat in my abdomen remains, despite a vigorous diet and exercise regimen. Now my buttocks are starting to "waste" or lose fat. I am considering liposuction and a tummy tuck for my fat abdomen. My question is this -will the fat return to my abdomen after the surgery? Do you know of any other HIV+ men who have had fat removed from their abdomen....does the fat return? Thanks for your help.

Response from Ms. Fields-Gardner

The whole issue of HAART and fat is a bit more complicated that what is typically gained by overeating or exercising. First things first... find out where that fat is! If it is deposited around the belly and just under the skin (jelly roll stuff that you can grab a hunk away from your abdomen), then checking on eating well is a thing to do. Eating well doesn't always mean a "rigorous diet," but it does mean eating appropriately to support your body while it loses the fat you wish to lose. However, if your butt or elsewhere seems to be losing fat, then it could be even more of a problem if you choose to rigorously diet. If you have a more rigid belly (one that doesn't flatten and spread a bit when you lie on your back), then it may be the type of fat that you cannot suck out. It could be viscerally deposited in and amongst your vital organs. This type of fat may be related to chronic disease and insulin resistance as well as exacerbated by the medications, drop in viral load, and other factors. There are only extremely limited studies in this area that suggest that exercise, some diet modulation, and lipolytic medications may help. There are even more limited studies about body dimension changes when you interrupt HAART therapy. Diet modulation strategies have not been well-tested, so there is not much one can universally say at this point. It is something that we are learning about, bit by bit and (unfortunately) piece by piece. Fitting the pieces together has yet to be done. But there are a few things to keep in mind while we search... Survival and preservation of important lean body stores should remain at the top of your list.


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