title: Development of Buffalo Hump in the course of antiretroviral therapy including raltegravir and unboosted atazanavir: a case report and review of the literature.
abstract: BACKGROUND
  The availability of raltegravir plus atazanavir provides an alternative antiretroviral strategy that may be equally efficacious and less toxic than those currently recommended in HIV treatment guidelines. In fact, this new combination antiretroviral therapy attracts the attention of the scientific community because both drugs have a good safety profile coupled with potent antiviral activity, and their combined use would avert nucleoside- and ritonavir-related toxicities.
  
  
  METHODS
  We describe the case of a 47-year-old, Caucasian woman treated for HIV-1 infection who developed Buffalo Hump during antiretroviral therapy, including raltegravir and unboosted atazanavir. Clinical evaluation and an ultrasonography scan of the cervical region showed a new progressive increase of lipohypertrophy and the results of DEXA confirmed these data. In our patient the worsening of the Buffalo Hump cannot be attributed to hypercortisolism; insulin-resistance, diabetes, dyslipidemia, hyperlactatemia and metabolic syndrome were not present. Moreover, she was not in therapy with antiretroviral drugs that are described as the cause of Buffalo Hump; on the other hand she developed this side effect three months after the switch of the antiretroviral therapy to raltegravir plus unboosted atazanavir.
  
  
  CONCLUSIONS
  Current data indicate that the etiology of HIV-associated Buffalo Hump remains elusive but is likely multifactorial; a possible contributing cause, but not the main cause, could be exposure to antiretroviral drugs. To the best of our knowledge, this is the first report on development of Buffalo Hump in the course of antiretroviral therapy, including the use of these drugs. On the basis of our data we can formulate the hypothesis of a pharmacological pathogenesis that underlies the development of this case of Buffalo Hump in the absence of other risk factors.
authors.affiliation: Department of Infectious Diseases and Public Health, "Sapienza" University, Rome, Italy. giancarlo.ceccarelli@uniroma1.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Ceccarelli
authors.forename: Gabriella
authors.initials: G
authors.lastname: d'Ettorre
authors.forename: Francesco
authors.initials: F
authors.lastname: Marchetti
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rizza
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Mastroianni
authors.forename: Bruno
authors.initials: B
authors.lastname: Carlesimo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo