Liposuction and surgical fat removal offer safe and long-lasting treatments for buffalo hump, one of the aspects of body fat redistribution seen in some patients treated with HAART, according to an Italian study involving 18 individuals and published in the February 20th edition of AIDS.
A large Italian cohort study found that between 2.3% and 3% of treatment- naïve patients developed buffalo hump, fat accumulation between the shoulders and the rear of the neck, after a median of 86 weeks of HAART.
Treatment strategies to correct this body fat disturbance include changing anti-HIV treatments, exercise, diet modification and drug and hormonal therapies. However, none of these have been found to lead to a substantial improvement in symptoms.
Because of this, corrective surgery has been proposed as a solution for this and other body fat changes, most notably (and successfully) New Fill treatment for facial wasting.
There have, however, been concerns that because patients will remain on antiretroviral therapy, there will be a high rate of relapse after surgical procedures to address buffalo hump.
Italian investigators followed 18 patients (14 of whom were men) who had either liposuction or surgical fat removal to treat buffalo hump. As well as experiencing changes in their body shape, all the patients in the Italian case series suffered from restricted neck movement, abnormal posture, and back pain.
The patients had a median age of 43 years, a median CD4 cell count of 573 cells/mm3 and 14 individuals had an undetectable viral load. All but two patients were taking a HAART regimen which included a protease inhibitor; the other two patients were taking a non-nucleoside-based regimen. At the time of surgery to correct buffalo hump, the median period of treatment with HAART was 32 months.
Fifteen patients had liposuction and three patients had surgical fat removal. No individual experienced post-surgery complications.
The median period of post-surgery follow-up was 19 months, and buffalo hump relapsed in one patient who had received liposuction and who was being treated with a HAART regimen including d4T, 3TC and efavirenz.
The investigators note that although surgical removal of fat was used successfully in three patients, this technique leaves scars, has a long operating time, can have a high incidence of post-operative complications and has a long recovery time. By contrast, liposuction was found to be simpler and more efficient, having the advantage of good hump correction, shorter operating time, less scarring, a lesser risk of complications and quicker recovery.
In particular, the investigators draw attention to the advantages of the “wet form” of liposuction. This technique involves the injection of very large volumes of a solution containing lidocaine and epinephrine into the fat mass, in order to allow the fibrous component to be broken down more easily by a surgical scoop called a curette. This technique enhances local anaesthesia, reducing post-operative pain, reduces blood loss and ensures a smoother post-operative skin surface.
“Despite the continuation of antiretroviral therapy, the effects of surgery in our series of patients have proved to be relatively long-lasting except in one case,” conclude the investigators.
Further information on this website
New form of liposuction able to reduce buffalo hump - at least in the short term - news story
Fat accumulation at the front of the neck - another aspect of lipodystrophy in HIV patients - news story
Body fat changes on HAART - overview
pdf of the Lipodystrophy booklet in the information for HIV-positive people series
Gervasoni C et al. Long-term efficacy of the surgical treatment of buffalo hump in patients continuing antiretroviral therapy. AIDS 18: 574 – 576, 2004.