HIV-associated cervicodorsal lipodystrophy: etiology and management.
OBJECTIVE
To familiarize the otolaryngologist with the evaluation and management of cervicodorsal manifestations of lipodystrophy in patients who have been treated with HIV protease inhibitor medications. In addition, to share the benefits obtainable with ultrasonic tumescent liposuction treatment.


METHODS
Retrospective chart review of patients presenting to the senior author with symptomatic hypertrophic cervicodorsal fat pad attributable to HIV infection and HIV protease inhibitor use.


RESULTS
Eight patients presented for evaluation of hypertrophic cervicodorsal fat pads between January 1, 2002 and December 31, 2004. All patients had been on protease inhibitors in the past and had minimal resolution after discontinuing offending agent. Most common presenting problems include disfigurement, limited range of upper extremity and neck motion, neck and back discomfort, and difficulty with sleep including sleep-study-confirmed obstructive sleep apnea. Five of eight patients underwent ultrasonic tumescent liposuction. Three patients had satisfactory improvement of symptoms after the first surgery, whereas the other two required additional operative sessions. No complications of hematoma, seroma, infection, prolonged pain, or re-accumulation of fat pad were encountered. The primary obstacle in the three nonoperative patients was insurance denial on the basis of deemed lack of established necessity.


CONCLUSIONS
Cervicodorsal lipodystrophy is a well-recognized outcome of prolonged HIV infection and side effect of certain HIV medications. Patients may present with both esthetic and functional issues related to the excess tissue. Although cessation of associated medications may halt further progression, this alone does resolve the symptoms. Ultrasonic tumescent liposuction is shown in this study to be a well-suited modality for reduction of this fibrous adipose tissue. Multiple sessions may be necessary to achieve satisfactory results because of the tenacity of the tissue. It is important for the otolaryngologist to be familiar with the head and neck issues relevant to this disorder and its treatment.
Gold
Daniel R
DR
Department of Otolaryngology-Head and Neck Surgery, TUFTS University School of Medicine, Boston, Massachusetts, USA.
Annino
Donald J
DJ
D000328:Adult; D005260:Female; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D015187:Lipectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009333:Neck; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014464:Ultrasonic Therapy / Q000379:methods*
D017320:HIV Protease Inhibitors