Infectious Complications of Bio-Alcamid Filler Used for HIV-Related Facial Lipoatrophy

Nadarajah, Jeya; Collins, Micaela Langille; Raboud, Janet; Su, DeSheng; Rao, K. Rajashekar; Loutfy, Mona; Walmsley, Sharon

doi:10.1093/cid/cis745

Cited by 20 publications

(10 citation statements)

References 30 publications

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“…Embolization of the permanent filler Bio-Alcamid, resulting in ARDS, is a radical manifestation not commonly observed in other cases of temporary dermal filler embolization. Though rare, embolization resulting in pulmonary embolism of other soft dermal fillers, such as polyacrylamide, resulting in death has been reported [17].…”

Section: Discussionmentioning

confidence: 99%

Embolization of Bio-Alcamid Gluteal Injections in a Female Patient with Patent Foramen Ovale Leading to ARDS and Embolic Stroke

Bolduc

Abdalla

Choudhry

et al. 2019

Reports

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Bio-Alcamid is a non-FDA approved permanent dermal filler with a few known adverse effects including granuloma formation at injection site, skin infections, abscess and painful inflammation. Embolization of Bio-Alcamid has not been reported and likely represents a very rare complication. We present the case of a thirty-one-year-old female who presents with cough, dyspnea, hemoptysis, fever, and pleuritic chest pain several hours after receiving Bio-Alcamid gluteal injections. The patient’s symptoms progress rapidly and, within three days, she develops acute respiratory failure requiring intubation. A chest x-ray consistent with acute respiratory distress syndrome (ARDS) is viewed. Concurrently, a 2D echocardiogram reveals a patent foramen ovale (PFO) and severe pulmonary hypertension. Five weeks after initial presentation to the emergency department, the patient demonstrates flaccid quadriplegia, is poorly responsive when sedation is held, and her CT scan of the brain showed multifocal infarcts involving bilateral cerebral hemispheres. A CT of the abdomen reveals renal and splenic infarcts. This case study presents a rare complication of a nonbiodegradable dermal filler, Bio-Alcamid.

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Section: Discussionmentioning

confidence: 99%

Embolization of Bio-Alcamid Gluteal Injections in a Female Patient with Patent Foramen Ovale Leading to ARDS and Embolic Stroke

Bolduc

Abdalla

Choudhry

et al. 2019

Reports

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“…PAIG induces skin tissue to form a fibrous capsule around the deposit. 63 An open-labeled, randomized study investigated immediate versus delayed PAIG treatment in 31 patients with HIV 9 (LOE 2b). At Remains permanently in the skin without undergoing significant loss; the formation of a collagen capsule around the microdroplets may maintain the position of the droplets.…”

Section: Polyalkylimide Gelmentioning

confidence: 99%

A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA)

Jagdeo

Ho²,

et al. 2015

Journal of the American Academy of Dermatology

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HIV facial lipoatrophy (FLA) is characterized by facial volume loss. HIV FLA affects the facial contours of the cheeks, temples, and orbits, and is associated with social stigma. Although new highly active antiretroviral therapy medications are associated with less severe FLA, the prevalence of HIV FLA among treated individuals exceeds 50%. The goal of our systematic review is to examine published clinical studies involving the use of filler agents for aesthetic treatment of HIV FLA and to provide evidence-based recommendations based on published efficacy and safety data. A systematic review of the published literature was performed on July 1, 2015, on filler agents for aesthetic treatment of HIV FLA. Based on published studies, poly-L-lactic acid is the only filler agent with grade of recommendation: B. Other reviewed filler agents received grade of recommendation: C or D. Poly-L-lactic acid may be best for treatment over temples and cheeks, whereas calcium hydroxylapatite, with a Food and Drug Administration indication of subdermal implantation, may be best used deeply over bone for focal enhancement. Additional long-term randomized controlled trials are necessary to elucidate the advantages and disadvantages of fillers that have different biophysical properties, in conjunction with cost-effectiveness analysis, for treatment of HIV FLA.

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“…Permanent fillers (polyalkylamide and polymethylmethacrylate) are synthetic materials that permanently fill in the space caused by loss of facial fat. Permanent fillers are not approved by the US Food and Drug Administration (FDA) and can possibly be associated with more implant-associated complications 49,50. Temporary fillers are biodegradable and immunologically inert material but have to be reinjected several times 49,51.…”

Section: Fat Atrophymentioning

confidence: 99%

HIV-associated lipodystrophy: a review from a Brazilian perspective

Alves¹,

Brites²,

Sprinz³

2014

TCRM

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The prognosis of human immunodeficiency virus (HIV)-infected individuals has dramatically improved worldwide since the introduction of highly antiretroviral therapy. Nevertheless, along with the decrease in mortality, several body modifications not initially related to HIV infection have been reported. Disorders in lipid and glucose metabolism, accompanied by body shape abnormalities and alterations in fat distribution, began to be described. A syndrome, named “HIV-associated lipodystrophy syndrome”, was coined to classify these clinical spectrum aspects. This syndrome involves not only metabolic alterations but also fat redistribution, with lipoatrophy due to subcutaneous fat loss (predominantly in the face and lower limbs) and lipohypertrophy related to central fat gain. These changes in body shape are very important to be recognized, as they are associated with worse morbidity and mortality. Self-esteem difficulties related to body alterations might lead to treatment failures due to medication adherence problems. Moreover, these alterations have been associated with an increased risk of cardiovascular events. Therefore, it is extremely important to identify this syndrome early in order to provide an even better quality of life for this population, as the clinical approach is not easy. Treatment change, medications to treat dyslipidemia, and surgical intervention are instruments to be used to try to correct these abnormalities. The aim of this study is to review clinical presentation, diagnosis, and management of body shape and metabolic complications of HIV infection from a Brazilian perspective, a medium income country with a large number of patients on antiretroviral therapy.

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Infectious Complications of Bio-Alcamid Filler Used for HIV-Related Facial Lipoatrophy

Abstract: Bio-Alcamid treatment of HIV-related FLA was associated with a high rate of infectious complications, often presenting years after treatment. Antibiotic prophylaxis should be considered in patients with Bio-Alcamid prior to dental work or facial manipulation.

Cited by 20 publications

References 30 publications

Embolization of Bio-Alcamid Gluteal Injections in a Female Patient with Patent Foramen Ovale Leading to ARDS and Embolic Stroke

Embolization of Bio-Alcamid Gluteal Injections in a Female Patient with Patent Foramen Ovale Leading to ARDS and Embolic Stroke

A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA)

HIV-associated lipodystrophy: a review from a Brazilian perspective

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