AEGiS-10CROI: Long-term Efficacy of Buffalo Hump Surgical Treatment in Patients Continuing Antiretroviral Therapy.

10th Conference on Retroviruses and Opportunistic Infections


Boston, MA USA - February 10 -14, 2003

Print this Article


Long-term Efficacy of Buffalo Hump Surgical Treatment in Patients Continuing Antiretroviral Therapy.

Conf Retroviruses Opportunistic Infect 2003 Feb 10-14;10th: abstract no. 723
Gervasoni C, Vaccarezza M, Fedeli P, Ridolfo AL, Rovati LC, Galli M; L Sacco Hosp, Milan, Italy

BACKGROUND: Fat redistribution disorders are common complications of antiretroviral (ARV) therapy. Corrective surgery is used with increased frequency to treat localized fat accumulation difficult to be reverted with medical treatment and/or ARV drug regimen modification. The most relevant restrain for surgical approach is represented by possible relapses due to continuation of ARV therapy. Objective: To assess the long-term outcome of the surgical treatment for stabilized fat accumulation in the dorsal-cervical region in ARV-treated patients (pts).

METHODS: A consecutive series of pts with buffalo hump (BH), with or without dorsal fat pad (DFP) enlargement, were treated with liposuction (WET-technique) or surgical removal and followed up with serial measurements.

RESULTS: Eighteen (18) pts (4 women and 14 men) were followed up after surgery for at least 6 months. Sixteen (16) had BH and 2 BH + enlarged DFP. At the first evidence of fat accumulation, 16 pts were on combined ARV therapy including a protease inhibitor (PI) whereas two were PI naïve pts on regimen including non nucleoside reverse transcriptase inhibitor (NNRTI). Eleven (11) pts switched from PI to NNRTI for a median time of 14 months (range 10-24) before surgery without significant modification of the dorsal-cervical mass. At the time of surgery, pts were aged 35-68 years (median 43) and had CD4 cell count ranging from 101-929 cell/mmc (median 573 cell/mmc);14 pts had undetectable viral load, while in the other 4 the median HIV-RNA was 47,512 copies/mL (range 3103-200,000). All the pts reported serious restriction in neck movement and aesthetic concerns, and they urged a possible surgical treatment. Fifteen (15) pts underwent liposuction and three surgical removal. During a median follow-up of 10 months (range 3-28) BH relapsed only in 1/18 cases (5.5%). In this pt, the occurrence of BH became evident 3 months after liposuction, while he was receiving efavirenz + stavudine + lamivudine. No local infection and surgical complications were reported. After surgery all the pts maintained ARV therapy (including PI in 5 cases).

CONCLUSIONS: Surgical treatment of BH had a long-term favorable effect in the large majority of pts continuing ARV therapy and may be considered in pts with relevant physical or psychological discomfort.

Keywords: AEGIS, CD4 Lymphocyte Count, Viral Load, Anti-HIV Agents, HIV Infections, Reverse Transcriptase Inhibitors, Antiretroviral Therapy, Highly Active, Lamivudine, Human, Female, Male, therapy, surgery, drug therapyKWDaegis,cd4lymphocytecount,viralload,anti-hivagents,hivinfections,reversetranscriptaseinhibitors,antiretroviraltherapy,highlyactive,lamivudine,human,female,male,therapy,surgery,drugtherapy

030210
723

Copyright © 2003 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.