BACKGROUND
Long-term treatment with antiretroviral medications, especially with protease inhibitors, has been shown to cause a syndrome called HIV-associated lipodystrophy.1 Lipodystrophy manifests as both lipoatrophy in the face and extremities and lipohypertrophy in such areas as the dorsocervical region (buffalo hump), lower abdomen, and breast (breast enlargement or gynecomastia). At this time, a number of medical, pharmacologic, and surgical therapies are used to treat HIV lipodystrophy. However the optimal therapeutic approach is still under discussion.2,3,4,5,6,7 We present a report of an alternative non-surgical technique of buffalo hump reduction.
CASE REPORT
A 52-year-old Caucasian man, HIV positive in HAART (Highly Active Anti-Retroviral Therapy) treatment for 12 years prior to presentation, was referred to my office for management of lipodystrophy. He showed facial lipoatrophy (grade 3 in James facial lipoatrophy severity scale) and a mild buffalo hump deformity. After physical examination, liposuction of the dorsocervical fat pad, and structural fat graft of the face was proposed, but patients refused surgery. As alternative treatment, polyacrylammide gel injection for facial wasting rehabilitation, and the injection of an adipocitolitic aqueous micro-gelatinous solution (intralipotherapy) for buffalo hump reduction was proposed.
Patient was fully explained about no experience about buffalo hump treatment with intra-lipotherapy, but he accepted the treatment and informed consent was firmed.
Before buffalo hump treatment, an ultrasonographic examination, and photographic documentation of the dorsocervical fat pad were performed. Three sessions were performed, one every 3 weeks; in each session a vial of 8 mL of an aqueous micro-gelatinous solution (Aqualyx), plus 0,2 mL of lidocain (as explained by the producer), was injected. As indicated by the producer specific needle were used (lipoinject needle - marllor int. Italy).
At each session the area to be injected was carefully cleaned with clorexidine 0,2%; steryle gloves were used by the physician, asepsis rules were followed; no antibiotic therapy was performed after treatment. After each session a light swelling and ecchymosis were referred by the patients for about 7 days. No major, nor minor complications were registered.
Clinical improvement was documented by photos (Figures 1, 2, 3, 4) and was reported by the patient after each treatment.
Four weeks after last session a new ultrasonographic examination was performed to assess the result, it showed 5 mm reduction of the dorsocervical fat pad. An 18-month follow up showed no relapse of the dorso-cervical fat hypertrophy (Figure 5)
DISCUSSION
Buffalo hump deformity is a well-described manifestation of HIV-associated lipodystrophy. Treatment for cervicodorsal fat pad (buffalo hump deformity) enlargement has been challeng-
