Ask Dr. Jeff
Question: Some of my friends have had surgery to correct body shape changes caused by the HIV drugs. What is your opinion of this option?
Answer: The two major body shape changes that may be modified with plastic surgery are facial fat loss, and the so-called buffalo hump, or a fat pad on the back of the neck. Some people with loss of facial fat have had surgical implants or injections to fill out their cheeks. The results of the implant surgery can be quite good. The silicon implants are permanent. Also, some surgeons will suction fat from other areas of the body and use it to fill facial areas. However, most people with significant fat loss in the face also have lost most of the fat under the skin of their arms and legs, so there is not too much fat available from other areas.
There is a new product which is a synthetic polylactic acid, called New-Fill. It is an injectable substance used to fill in areas of fat loss. However, the FDA has put a hold on the use of the substance in the U.S. For a full discussion of New-Fill see the excellent article from Positively Aware at: www.thebody.com/tpan/janfeb_02/newfill_t20.html.
The use of liposuction for removal of a buffalo hump can be very successful. A few years ago there was concern that the fat would quickly reform following liposuction. However, the people I know who have had liposuction have not experienced this problem.
The increased fat in the abdominal cavity that some people develop cannot be corrected with liposuction. This is because liposuction can remove fat from only under the skin. In people who develop the "protease paunch," the fat surrounds the internal organs, and is not under the skin.
The biggest challenge in seeking out plastic surgery to correct body shape changes caused by HIV treatment is paying for it. Almost all healthcare plans consider the above procedures to be cosmetic, meaning they will not pay for it. Some people have convinced their healthcare plan to pay for liposuction to remove a buffalo hump. The more documentation that the patient can produce showing that the fat deposit at the back of the neck is causing pain, sleeping problems, or other symptoms, the greater the chance of convincing a healthcare plan to pay for the procedure. However, I know people with large buffalo humps and significant pain and discomfort who have been unable to convince their healthcare plan to pay for the liposuction.
In general, I think that not as many people on treatment for HIV are developing major body shape changes as was once feared, although some definitely are. However, the disappointing results of trials that test switching from drugs thought to cause these problems, and the lack of encouraging results from early studies of insulin-sensitizing drugs means that, for some people, surgery will continue to be their best chance of reversing some of the fat loss or gain caused by their HIV treatment.
Management of Metabolic Complications Associated With Antiretroviral Therapy for HIV-1 Infection: Recommendations of an International AIDS Society-USA Panel
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Perspective.