Buffalo Hump: What the Experts Suggest

A patient comes to see you in some distress; he points out a fat pad at the posterior of his neck, easily evident from the side or back, which he says is becoming more prominent. He also believes that there is a fatty infiltrate at the base of his skull. Plain skull films and an MRI of the skull are normal. He refuses to consider changing his medications and asks for a referral to a plastic surgeon.

Juan C. was diagnosed with AIDS in 1997 at age 23, when he arrived at the hospital with dyspnea and was found to have pericardial tamponade. His CD4 count was 23 cells/mm³, and he had disseminated MAC. He was started on AZT + 3TC + indinavir. From the beginning he tolerated his regimen quite well, and it has never been changed. His CD4 count slowly rose to the range of 600-700 cells/mm³, and his viral load has been largely undetectable. His adherence is excellent.

He comes to see you in some distress. He is now almost 30, and quite conscious of his physical appearance. He points out a fat pad at the posterior of his neck, easily evident from the side or back, which he says is becoming more prominent. He also believes that there is a fatty in…

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Peter J. Piliero, MD and Grace A. McComsey, MD

Buffalo Hump: What the Experts Suggest

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