Hello Dr.Feinberg: My husband is HIV positive. He has recently gained weight. His breast are large. My question is this in any may associated with the disease or maybe the medication (comivir, sustiva) or just natural weight gain. He is a man with a slim build, he weight gain in concentrated to upper torso. Thank You.

No one knows for certain why fat build-up occurs in certain body locations-- it is very likely a complex process that may include normal aging, HIV itself and the drus used to treat HIV. It is pretty difficult to reverse these fatty deposits, which are termed "lipodystrophy". Sometimes the breast enlargement in men is not fat but increased breat tissue, which is called "gynecomastia", and in unusual cases breast enlargemnt can be due to the development of breast cancer although this usually is confined to one side and isn't symmetrical. The way to determine whether it's benign gynecomastia or something more worrisome is to get a mammogram. If is is just fat deposits, then other than exercise and watching one's diet, it is pretty difficult to do anything about it. Some people have tried liposuction, but there are no data regarding its long-term usefulness.