Paul Caleo was diagnosed with HIV in 1988 and began the protease inhibitor Saquinavir in March 1996.
"The arrival of protease inhibitors saw my health stabilise and then greatly improve. My energy levels increased and I was able to return to work and lead an active life once again. Knowing treatments and outcomes were improving over time reinforced my positive outlook,” said Paul.
Paul had noticed muscle wasting in his arms and legs after several years on AZT and later d4T, the commonly used ARVs at the time. Further changes to his body shape started occurring when the protease Saquinavir and later Indinavir were added to his regimen. It contributed to him developing a belly and a "buffalo hump", a large fat deposit on his upper back and shoulder area.
"The doctors at the time were seeing quite a lot of it with HIV-positive people," said Paul. "The recommended way to get rid of the buffalo hump was a 'humpectomy' or a surgical removal of the fat deposit. I felt I had no choice as the hump was incredibly uncomfortable. Whenever I lay down I would feel the pressure on my neck and shoulder, and it was unsightly. The surgery was successful despite leaving a long scar. I'd also developed fat deposits around the front of the neck but the surgeon said that was too difficult to treat."
There seemed to be no way to get rid of the belly though. "As with the buffalo hump, no amount of exercise seemed to change the size of the belly significantly. I knew it was caused by the accumulation of visceral fat in my stomach so I was not surprised that I had an increased cardiovascular risk as well."
This year, however, Paul has finally had some success in reducing his belly size. Late last year he joined a ten-week course called "Activate" run by the Albion Street Centre in Sydney.This tailored exercise and lifestyle program includes three exercise groups per week; weekly self-management discussion groups (including nutrition, mindfulness, meditation, motivation, bone and oral health); and individualised nutrition interventions. The dieticians supported Paul to develop a program which regulated the food he ate (helped by keeping a food diary and an exercise physiologist worked with him on an exercise program three times a week.
"The exercise program was particularly aimed at developing core strength," said Paul. "There were a lot of stomach crunches, squats and lunges and running up and down stairs. The strength training used resistance bands so that the exercises didn't need to be done in a gym. You could do everything at home or you could participate in group exercise classes.
"The dietary regimen is about portion control and making healthier food choices such as excluding fried foods, sugar and salt, as much as possible. After doing the ten-week program and following through with the regimen, Paul has lost 17 kilograms, increased his lean body mass and now finds his energy levels and sense of wellbeing greatly improved. The belly has been greatly reduced as have his risk factors for cardiovascular disease, diabetes and osteoporosis."
Paul recommends HIV-positive people who want to try the same thing — but who might not have a program where they live — try to seek out an exercise physiologist. "You can get up to five sessions with a physiologist if you are eligible for the government's Chronic Disease Management program. Your GP can arrange this."