A form of liposuction, assisted by ultrasound, appears to offer safe, if transient reduction of fat accumulation at the back of the neck, or “buffalo hump,” according to a small study published in the on-line edition of Clinical Infectious Diseases.
Buffalo hump is one element of lipodystrophy, a syndrome which is believed to be caused partly by anti-HIV drugs and is characterised by metabolic disturbances and/or unusual body fat distribution.
The use of cosmetic treatments to remedy fat loss in the face is becoming increasing available from both NHS and private providers, and liposuction has been safely and successfully used by some individuals to remove fat deposits from the abdomen and back of the neck.
Investigators in Albany, New York State, wished to see how safe and effective liposuction assisted by ultrasonography (ultrasound used for imaging) was for the treatment of buffalo hump. Ultrasonography–assisted liposuction (UAL) is a relatively new procedure and has safety advantages over traditional liposuction, particularly as it allows liposuction to be performed on fibrous areas and other parts of the body where traditional liposuction is not possible.
A retrospective review of the records of ten HIV-positive patients who underwent UAL between 1994 and 2002 was conducted. The average age of patients was 46 years, eight were men, six were white and four African-American. Half of the patients had been diagnosed with AIDS, and the mean duration of HIV infection before the appearance of buffalo hump was a little over eight years. Anti-HIV therapy had been used for an average of 5.4 years before buffalo hump was diagnosed and patients had used a mean of 5.6 anti-HIV drugs.
Prior to the initiation of HAART, the study members had reached an advanced stage of immune damage, with mean nadir CD4 cell count being 139 cells/mm3. At the time when body fat changes were diagnosed, mean CD4 counts had increased to 400 cells/mm3 and mean viral load was a little over 10,000 copies/mL.
HAART was being taken by nine individuals at the point when buffalo hump developed. Seven patients were taking the NRTI d4T, a drug that research suggests is particularly likely to cause mitochondrial toxicity and body fat disturbances (chiefly fat loss). Other metabolic and body fat disturbances were also present in all but one of the patients.
A total of twelve UAL procedures were performed on the ten individuals. The procedure was performed twice on two people due to relapse. All the procedures were associated with a partial reduction in buffalo hump size. However, in five patients the buffalo hump returned to the pre-procedure size with two individuals opting to have the operation repeated.
The procedures were well tolerated without any immediate side-effects, although two patients developed pneumonia within three months of the operation. Investigators were unable to say if this was associated with the procedure.
”Our experience suggests” conclude the investigators, “that UAL represents a well-tolerated, and effective treatment” of buffalo hump. However they note that 50% of their cohort experienced a recurrence of the condition, but “in lieu of other treatment options, UAL appears to be a reasonable surgical procedure.” They call for further cohort studies to evaluate its long-term efficacy.
Further information on this website
Body fat changes on HAART - overview
Lipodystrophy - booklet in the information for HIV-positive people series
Lipodystrophy - factsheets
Piliero PJ et al. Use of ultrasonography-assisted liposuction for the treatment of human immunodeficiency virus-associated enlargement of the dorsocervical fat pad Clinical Infectious Diseases 37 (on-line edition), 2003.