Question

What can I do about my buffalo hump?

11 July 2012. Related: Access to treatment, All topics, Side effects, South Africa.

I started taking ARVs in 2004. I was on stavudine and I developed buffalo hump and the distribution of fats is abnormal. My
doctor changed me to Atripla. The distribution of fats is not remedied.

I now feel abnormal and have a low-self esteem and I’m too fat.

How can I remedy the situation. I’m embarrassed.

Please help me also curb my appetite, because I eat too much.

Answer

Answer: Simon Collins

Thanks for posting a question  and allowing us to post the answer online.

Buffalo hump, apart from not having a great name, is one of the side effects that some people were unlucky to get using earlier treatment. It is less common now, but I’m sure hearing this doesn’t make you feel any better.

It is sad that you are feeling this way now, because you have clearly been so lucky in getting access to treatment. You also must have been so committed in taking the meds for them to have worked for so many years. These experiences make you an amazing woman and mean that you will have the strength to find a way through this. You shouldn’t let anyone make you feel embarrassed about how you feel or how you look.

Because you are also feeling depressed, your doctor should know about this in case there is something s/he can help with. This includes checking whether efavirenz (one of the drugs in Atripla) is causing the depression or making it worse. Efavirenz can affect your moods including making depression worse.

You mentioned wanting help with eating and that you feel you over eat, but this is something to talk about to your doctor too. Lots of people who have put on weight when on HIV treatment, think this is just about diet, so they cut back on eating everything. This is just as unlikely to help as over-eating. If you want to change things, this is likely to take time and happen slowly and getting advice from a health adviser or dietician might help. You have plenty of time to make these changes.

The following links below are for more information about different aspects of your question.

Although these studies are useful, you are clearly having a rough time right now. As well as talking to your doctor, it might help to find other people in a similar situation so you can support each other.

I wondered whether you were involved with Treatment Action Campaign (TAC) as they have a lot of branches in South Africa.

Please let me know if I can help with other information.

Further information

Information on efavirenz side effects.

Information on fat accumulation and lipodystrophy and possible treatments is at this link.

In the UK some people have liposuction for fat pads on the shoulder or neck. This is pretty successful in at least half the cases, but in some people the fat returns again. It is also a serious surgery that is free here, but may not be easy to access in other countries. Still, it would be worth asking your doctor about this.

This is a link to a study about liposuction in HIV.

However, some researcher in the USA ran a large study that report that shoulder fat was common – in 10% or HIV negative Americans. The reported this to be one of many symptoms associated with increased weight and being over weight.

If you have put on weight generally, in the long term, making changes to a more active life with a healthier diet, might help reduce the shoulder fat as well as other fat.

This is probably a slow process. You could set small goals that are easier to achieve. It involves eating a balanced diet and becoming more active. This study reported that diet and exercise can reduce symptoms.

These links include information about a balanced diet and leading a more active life.