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Body fat redistribution (‚lipodystrophy‚), with gain in abdominal and trunk fat, and decline in facial and limb fat, is a newly recognized problem in patients with HIV infection that has been linked to use of HIV-1 protease inhibitors. Increased abdominal fat may predispose these patients to hypertension, diabetes, and coronary artery disease. At this time no effective treatment is available. We examined whether exercise training could reduce trunk fat in men with fat redistribution.Open-label pilot study.Ten men with increasing abdominal girth participated in a 16 week pilot study of progressive resistance training with an aerobic component. They trained in a community health club three times per week. Total body lean and fat mass, and trunk fat mass, were assessed by dual-energy x-ray absorptiometry (DXA).After 16 weeks of exercise, strength increased for three of the four exercises tested (leg press + 13% [p<0.02], leg extension + 19% [p<0.03], seated row + 7% [p<0.13], chest press + 18% [p<0.005]). There was a significant decline in total body fat by 1.5kg (=2.1 percentage points, p<0.01); most of the decline in body fat occurred in trunk fat, which decreased by 1.1kg (p<0.03). Weight, lean mass (+ 1.1±2.6kg, p=0.23), and bone mineral density measured by DXA did not change. No adverse effects were seen from the training.Exercise training may reduce trunk fat mass in HIV-positive men with fat redistribution.Controls trials of this approach are warranted.