Reconstructive treatment for antiretroviral-associated facial lipoatrophy: a prospective study comparing autologous fat and synthetic substances

Lipodystrophy is one of the foremost concerns among the HIV-positive population, and is often associated with psychosocial disorders. We evaluated the clinical efficacy of facial infiltrations with autologous fat, polylactic acid, and polyacrylamide gel using clinical inspection and facial photograp...

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Bibliographic Details
Published in:	AIDS patient care and STDs Vol. 20; no. 12; p. 829
Main Authors:	Negredo, Eugenia, Higueras, Carmen, Adell, Xavier, Martinez, Juan Carlos, Martinez, Eva, Puig, Jordi, Fumaz, Carmina R, Muñoz-Moreno, Jose A, Perez-Alvarez, Nuria, Videla, Sebastia, Estany, Carla, Cinquegrana, Denise, Gonzalez-Mestre, Vicente, Clotet, Bonaventura
Format:	Journal Article
Language:	English
Published:	United States 01-12-2006
Subjects:	Acrylic Resins - therapeutic use Adipose Tissue - transplantation Adult Anti-Retroviral Agents - adverse effects Cosmetic Techniques Face Female Follow-Up Studies HIV-Associated Lipodystrophy Syndrome - chemically induced HIV-Associated Lipodystrophy Syndrome - classification HIV-Associated Lipodystrophy Syndrome - surgery Humans Lactic Acid - therapeutic use Male Middle Aged Patient Satisfaction Polyesters Polymers - therapeutic use Prospective Studies Quality of Life Risk Factors Severity of Illness Index Time Factors
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Summary:	Lipodystrophy is one of the foremost concerns among the HIV-positive population, and is often associated with psychosocial disorders. We evaluated the clinical efficacy of facial infiltrations with autologous fat, polylactic acid, and polyacrylamide gel using clinical inspection and facial photographs (ordinal scale). Additionally, we assessed the safety of the infiltration techniques and determined changes in patient satisfaction, emotional status, and quality of life. Evaluations were made at 48- and 96-week follow-up visits. This paper presents the 48- week follow-up results. The current analysis includes 138 patients: 8, 25, and 105 in the fat, polylactic acid, and polyacrylamide gel groups, respectively. At baseline, almost 50% of the patients (67/138) presented grades 3 and 4 lipoatrophy, but at week 48 only 7.5% (7/93) remained in these advanced grades (no patients from the polyacrylamide group). A new round of infiltrations at week 48 was necessary in 35% (33/93) of patients (88%, 84%, and 8% in the fat, polylactic, and polyacrylamide groups, respectively). No serious adverse events were detected with any of the substances. Patient satisfaction and quality of life improved significantly in all three groups. Infiltrations with autologous fat, polylactic acid, or polyacrylamide gel appear to be an effective and safe alternative to repair facial lipoatrophy, at least up to 48 weeks, significantly improving patient quality of life. Similar results were observed for all degrees of severity and between genders. Polyacrylamide gel provided the longest lasting benefits.
ISSN:	1087-2914
DOI:	10.1089/apc.2006.20.829