By Gary M. White, MD

HIV-positive patients may develop loss of subcutaneous tissue, especially of the medial cheeks.


In mild cases, there is only loss of fat in the central face. Later, or in more advanced cases, loss of fat may occur on the limbs, and buttocks along with the accumulation of dorsocervical and abdominal visceral fat and gynecomastia.

A "bullfrog neck" is another potential feature of HIV and its treatment. A small series is reported of several men who, in addition to their features of facial lipoatrophy and “buffalo hump,” had the unique feature of circumferential enlargement of the neck. All patients were undergoing treatment with the same non–nucleoside reverse-transcriptase inhibitor medication, efavirenz [JAMA Derm 2010;146;1279].


A single treatment of hyaluronic acid filler can provide immediate improvement [JAMA Derm 2017;153;61].


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