10th Conference on Retroviruses and Opportunistic Infections Boston, MA USA - February 10 -14, 2003

Conf Retroviruses Opportunistic Infect 2003 Feb 10-14;10th: abstract no. 724
Piliero PJ, Hubbard MJ, King J, Faragon JJ; Albany Med Coll, NY

BACKGROUND: Fat maldistribution is an increasingly prevalent problem for HIV-infected patients (pts). This syndrome may manifest as fat gain, fat loss, or a mixed picture, and is sometimes associated with metabolic abnormalities. Enlargement of the dorsocervical fat pad leading to a "buffalo hump" (BH) is one such manifestation, and it can be disfiguring as well as associated with the development of neck pain and sleep apnea. As the pathophysiology of this syndrome has yet to be elucidated, no universal therapeutic option exists.

METHODS: One treatment option is ultrasound-assisted liposuction (UAL) of buffalo humps. We sought to retrospectively evaluate the outcome of such procedures in an urban clinic population. Pts with a history of UAL of a BH were identified by clinic providers. Charts were then reviewed and data extracted.

RESULTS: A total of 10 pts had 12 UALs. Pt characteristics: 6 men, 4 women; 8 Caucasians, 2 African-Americans; mean age 46 yrs (37-60); Mean duration of HIV diagnosis prior to BH: 8.1 yrs (3-13); CDC class C (5), B (3), (2). HIV-related features: all ARV-experienced for a mean of 5.4 yrs prior to BH; mean number of prior agents: 3.3-NRTIs, 1-NNRTI, and 1.3-PIs; mean CD4 nadir 139 cells/mm³ (8-497) with 7 being < 200 cells/mm³; mean current CD4 count 400 cells/mm³ (11-1,044); mean current viral load 10,445 copies/ml (-95,561) with all but one < 5,000 copies/ml; 9/10 pts were receiving NRTIs at the time their BH was diagnosed, 5 were receiving a PI or boosted PI, and 3 were receiving efavirenz. Additional features: metabolic complications included dyslipidemia (n = 9) and dysglycemia (n = 4). Eight (8) pts had other manifestations of fat maldistribution in addition to their BH. Evaluation of UAL: all 12 procedures were well tolerated. No pt had full resolution of their BH; all had initial partial reduction in BH size; however, 5 recurred, with 2 pts undergoing a second UAL. Two (2) pts developed pneumococcal bacteremia 1 and 3 mos post-UAL.

CONCLUSIONS: We describe 10 pts who underwent 12 UALs for BHs that developed after a mean of 8.1 yrs of known HIV infection and 5.4 yrs of ART. UAL was immediately well tolerated and associated with a partial reduction in BH size for all pts. However, 5 pts had re-accumulation of fat. Two (2) pts developed pneumococcal pneumonia and bacteremia within 3 mos of UAL despite each having had pneumococcal vaccination twice in their lifetime.

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