title: "Bullfrog neck," a unique morphologic trait in HIV lipodystrophy: case series and review of the literature.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-associated lipodystrophy is a syndrome that occurs primarily in individuals who are being treated with highly active antiretroviral therapy (HAART).
  
  
  METHODS
  We describe 3 patients with an 8- to 15-year history of HIV disease and HAART who presented a unique feature of HIV lipodystrophy, the "bullfrog neck." In addition to their features of facial lipoatrophy and "buffalo hump," patients had the unique feature of circumferential enlargement of the neck. All patients were undergoing treatment with the same non-nucleoside reverse-transcriptase inhibitor (NRTI) medication, efavirenz.
  
  
  CONCLUSIONS
  We present a novel finding of the bullfrog neck in 3 patients with classic features of HIV lipodystrophy. The dysmorphic features of HIV lipodystrophy present a significant therapeutic challenge because the current repertoire of treatments is only modestly effective, and the disease in patients who continue HAART regimens over the long term will progress. Review of the recent literature suggests that the individual protease inhibitors and NRTIs used may play a role in the development and progression of HIV lipodystrophy.
authors.affiliation: Department of Dermatology, Boston University School of Medicine, 609 Albany St, Boston, MA 02118, USA. etierney@bu.edu
authors.forename: Emily P
authors.initials: EP
authors.lastname: Tierney
authors.forename: C William
authors.initials: CW
authors.lastname: Hanke
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D048588:Benzoxazines / Q000009:adverse effects / Q000627:therapeutic use; D003521:Cyclopropanes; D015658:HIV Infections / Q000188:drug therapy; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz