Question:

I am a 65 year old man diagnosed with HIV in 1995. I am healthy and asymptomatic. Still on my original cocktail: Crixivan, Epiver, Zerit.

Although my weight is only 225 (I am 6' 7" tall), my waist has gotten quite large. My doctor calls it the "Crixivan belly" but offers no solutions. This is not just a vanity issue....I have non HIV-related spinal problems and the lipodystrophy exacerbates these problems.

Thus, my question....can you offer any suggestions? Is liposuction an option?

Answer provided by:

Peter Shalit, M.D.
Internal Medicine

Body shape changes seem to accompany antiretroviral therapy. The culprit is not clear and it is likely that there are multiple factors involved. Because the precise cause has not been found, the packaging for every HIV drug now includes a warning that changes in body fat distribution may accompany antiretroviral therapy. However, there are theoretical reasons to suspect that some of the newer antiretrovirals may be less prone to this effect, and some physicians would suggest changing your therapy, if it does not compromise your antiviral success.

The abdominal obesity which you are experiencing is very difficult to treat. The fat is not on the surface of the abdomen, but inside among the internal organs, so it cannot be removed by liposuction or surgery. An intensive program of diet and exercise has been shown to be beneficial in this situation. Medications such as anabolic steroids and human growth hormone can reduce body fat; however, this effect is indiscriminate (fat is lost from everywhere in the body). Also, the effect of these hormone type drugs tends to be temporary, and the problem recurs when the drug is stopped. Unfortunately, your doctor may be offering no solutions because there is no proven solution to this difficult problem.

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