Help may be at hand for that haggard Susan Hayward look. Four new treatments handle the fat.

If "get my face back" and other lipodystrophy-twisted body repairs top your New Year's resolution list, success may be just around the corner. Whether it's too much fat (in bellies, on backs and in the blood) or too little (sunken cheeks and shrunken limbs), researchers at ICAAC and the Lipodystrophy Workshop had good news on the fat-handling front.

French scientists say sunken cheeks and deepening wrinkles caused by facial fat loss (lipoatrophy) may be reversed with polylactic acid, a substance that promotes new formation of collagen, a skin protein. Every two weeks, 26 male HIVers who had facial wasting (severe in 20, moderate in five) while on antiretroviral drugs (87 percent on HAART that included a protease inhibitor) were given two injections (a total of 3 cc) into each cheek. The results were -- no better way to say it -- uplifting. Physical exams and ultrasound revealed dramatic increases in middle skin layer thickness: up 151 percent by the end of the third month and a whopping 196 percent after six months. Best of all, 22 of the 26 men said that their faces were once again their faces.

From both East and West coasts came reports of success with low-dose Serostim (human growth hormone) in getting fat out of all the wrong places. At the University of California at San Francisco and Berkeley, five HIVers with fat accumulation who completed six months of Serostim (3 mg a day via subcutaneous injection) saw reductions in abdominal girth and in buffalo humps. Insulin sensitivity and oral glucose tolerance (OGT) -- measurements of the body's ability to handle blood sugar -- worsened initially, probably a direct effect of the drug, but were almost back to pre-treatment levels after completion of six months of therapy. The blood sugar improvement was likely the result of a reduction in body fat. A sixth participant discontinued the growth hormone after only three weeks, however, because of elevated blood sugar. His baseline OGT testing showed pre-existing diabetes, leading the researchers to recommend OGT screening and excluding people whose results suggest a serious risk of Serostim-induced blood-sugar increases.

New York City-based researchers using even lower Serostim doses -- which both cut the cost and reduced joint swelling, pain and other side effects -- saw a 20 percent decrease in unwanted deep abdominal fat and a significant increase in muscle volume in 14 recipients. And that was with only 4 mg of the drug given every other day. Average fasting glucose levels rose, but did not reach troublesome levels. Good effects were acheived with less of the drug, fewer shots, reduced pain, and for a lower price -- could this be the wave of the future?

A pair of nutritional supplements -- an amino acid and a B vitamin -- is also demonstrating lipo-leveling promise. Although it had no effect on central fat accumulation or peripheral fat loss, German researchers found that the amino acid carnitine significantly reduced levels of both total cholesterol and LDL ("bad") cholesterol when given to 12 HIVers with lipo in doses of 1,000 mg, twice daily for three months. And San Francisco researchers who gave the B vitamin niacin to six HAART-takers with abdominal fat accumulation saw nice results: significant increases in HDL ("good") cholesterol and decreases in belly fat after 7 to 18 weeks of 1,000 mg, three times a day (doses were increased gradually to prevent the painful skin stinging and flushing that niacin can cause). Fat loss was increased with longer niacin therapy.

Researchers hypothesize that low levels of HDL, the carrier that transports cholesterol to the liver for processing and removal, are tied to increased need to store the blood fat, which ends up in the belly. They theorize that raising HDL could improve the body's ability to handle fat properly. It's one of many lipodystrophy theories, but, considering results seen so far, it looks like it just might hold water.