The HIV positive child

Introduction

Acquired immunodeficiency syndrome caused by the infection with the human immunodeficiency virus has become a chronic disease just like high blood pressure or sugar diabetes.

Disturbances in the processing and distribution of fat in patients with HIV/AIDS is common. The maldistribution of fat may be either as a cause of the disease or as a cause of the treatment. The fat maldistribution may either be too much or too little. The process of fat maldistribution is called lipodystrophy. Too much, hypertrophy or too little, atrophy are both problematic.

Many medical insurances will cover these procedures thus it is of value to contact the medical aid to confirm if they will cover the procedure on

The biggest problem is stigmatization or discrimination on the basis of a clinical features associated with the condition. There are numerous ways in which plastic surgery may minimise these characteristic features. Unfortunately they may reoccur requiring reoperation.

The areas most commonly affected are the face, neck, upper-back, breasts, abdomen and legs.

The face appears sunken with dramatic check bones. Around the neck it looks and feels like a giant double chin. There may be a collection of fat behind the nape of the neck which cosmetically appears very unattractive and even appears to be a deformity. Breasts and stomachs enlarge as those whom may seek a breast reduction or a tummy tuck. The buttocks and the legs may either increase in size or completely waste away.

There are many ways in which to address these issues depending on the size and consistency of the fatty collections. In some areas for example the nape of the neck the consistency may be very fibrous making surgical excision mandatory.

I always feel it is appropriate to exhaust the non-surgical options before progressing to the surgical options.

In terms of surgery I think it is important that the CD4 levels are greater than 200 and the viral load undetectable on treatment. It is my responsibility as a surgeon to ensure the safety of my patients. A CD4 of less than 200 is associated with opportunistic infections and no one should put their health at risk for the sake of a cosmetic procedure.

In terms of options available, well it is largely volume restoration or removal of excess.  And that by the way is the case with all plastic surgical procedures.

Volume Restoration

In terms of volume restoration our options are hyaluronic acid filler which works best for the face although temporary and costly. Fat transfer works well in all areas and is in my opinion the best option. Fat transfer involves a process of liposuction and fat injection. The transferred fat may behave unpredictably, absorb and require reinjection. Fat transfers are good options for the face, buttocks, lower legs and breast in certain cases. I generally do not like using silicone implants in patients with immunodeficiency conditions, but it can be done, the risk of infection however is much higher.

Removal of Excess Tissue

Non-surgical options for localised fat removal are limited and may require up to 6 sessions to see a difference. It involved the injection of a lipolytic agent which dissolves the fat cells. Besides the fact that you may need multiple injections the fat may reoccur. The advantage is that the procedure does not require surgical admission or anaesthesia.

Surgical options ae either liposuction or direct surgical excision of the affected area. Liposuction of face, neck, nape of neck, breasts, male breast tissue, abdomen, buttocks and legs all can be done. Large deposits however requires surgical excision. This is most commonly done as a beast reduction in females or a gynaecomastia correction in males, abdominoplasty, gluteal augmentation or augmentation of the legs.