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Q:

Have been taking regimen for hiv therapy for 14 yrs. Belly fat is a side effect. It just won’t seem to go away and is pretty rigid. It’s getting hard to even tie my shoes sometimes. Exercise has done nothing. Could this be considered medically necessary to get insurance coverage?

A:

Hello and thanks for posting.

Coolsculpting or cryolipolysis is a technique that targets subcutaneous fat for permanent reduction in the treated areas.

People living with HIV who have long-term exposure to antiretroviral therapy have an increased risk of metabolic abnormalities, including visceral fat deposition. There is also increased risk of unusual subcutaneous fat accumulations – the classic example is a cervico-dorsal fat pad or “buffalo hump”. The constellation of these findings are known as lipohypertrophy.

Unfortunately, Coolsculpting does not address visceral fat. I have used it successfully in HIV-infected patients with subcutaneous fat deposits, including a buffalo hump.

There is a medication call liraglutide, also known as Victoza and Saxenda that is FDA approved for diabetes mellitus and obesity. This medication has been found to reduce visceral fat in diabetics. Based on this observation, it might be useful in the treatment of excessive visceral fat in patients with lipohypertrophy.

I hope that this information helps and best of luck to you!

Regards,
Dr. Pierone

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