Large particle hyaluronic acid for the treatment of facial lipoatrophy in HIV‐positive patients: 3‐year follow‐up study

Abstract

ObjectivesFacial lipoatrophy can be a stigmatizing side effect of antiretroviral (AVR) treatment for HIV-infected patients. We sought to evaluate the long-term efficacy and safety of a new formulation of hyaluronic acid that can be injected in larger amounts and into deeper skin layers during 3 years of follow-up. Methods Twenty patients received injections of Restylane SubQ 2. Refill treatment was offered at 12 and 24 months. Treatment effects were evaluated using ultrasound, the Global Aesthetic Improvement Scale, visual analogue scale (VAS) and the Rosenberg self-esteem scale. ResultsSeventeen patients remained at 36 months. Mean (AE standard deviation) total cutaneous thickness increased from 6 AE 1 mm at baseline to 12 AE 1 mm (Po0.001) at 36 months. Response rate (total cutaneous thickness 410 mm) was 70%. Fifteen patients classified their facial appearance as very much or moderately improved. VAS increased from 39 AE 25 to 70 AE 20 (Po0.05) and higher self-esteem scores were reported. Local swelling and tenderness after treatment was common. Persistent papules found in several patients after treatment were removed effectively with hyaluronidase injections. Three patients, treated only at baseline, still had higher total cutaneous thickness scores at 36 months. ConclusionsOur results indicate that a large particle hyaluronic acid formulation is a durable and well-tolerated dermal filler for treating HIV-positive patients with facial lipoatrophy. IntroductionLipoatrophy is a particularly distressing aspect of lipodystrophy evident in HIV-positive patients on antiretroviral therapy (ART). Facial lipoatrophy can severely affect patients' quality of life and may contribute to reduced antiretroviral (AVR) adherence [1]. Furthermore, the stigmatization affected patients may encounter as a result of facial lipoatrophy can be detrimental for self-esteem [2]. Treatment strategies include switching AVR regimens, prescription of medication, insertion of surgical implants and injection of dermal fillers.While there is evidence that the use of new nonthymidine nucleoside reverse transcriptase inhibitors can prevent the development of lipoatrophy, switching medications, after lipoatrophy has progressed, offers only limited benefit [3,4]. A follow-up study of the Oslo HIV Cohort Study 2000 found that facial atrophy was less reversible than fat atrophy of the extremities [5]. Medications such as pioglitazone [6], uridine [7] and pravastatin [8] have been shown to have some effect on limb lipoatrophy in HIV-infected patients; however, the mechanisms by which they work and their potential side effects are not well documented.In the absence of a therapeutic intervention to reverse lipoatrophy, injection of soft-tissue fillers appears to be the simplest way to correct facial lipoatrophy. Many soft-tissue fillers, both biodegradable and permanent, have been studied in HIV facial lipoatrophy, however, long-term clinical safety and efficacy data are lacking. Biodegradable fillers have a good safety profile, but treatment with s...

Hyaluronic Acid Filler in HIV-Associated Facial Lipoatrophy: Evaluation of Tissue Distribution and Morphology with MRI

“…Cosmetic treatment of HIV-LA using cross-linked HA derivatives, collagen, L -polylactic acid and autologous fat has been reported [9,10,28]. HA is a polymer present in the extracellular matrix of the connective tissue.…”

“…However, to the best of our knowledge, no studies have yet evaluated the in vivo distribution of cross-linked HA and the mechanisms accounting for its efficacy in HIV-LA, as the focus of most published articles is on feasibility, local and general tolerance as well as subjective patient satisfaction [9,23,24]. Most authors assessed patient satisfaction by means of the Global Aesthetic Improvement Scale (GAIS) or the Quality of Life Assessment (QoLA) score [10,11], and only very few attempted to evaluate treatment results in a more objective manner by using ultrasonographic measurements of facial tissues [9,23].…”

“…Treatment strategies for HIV-associated facial lipoatrophy include soft tissue augmentation procedures performed using autologous fat grafting or injectable dermal fillers [8,9,10,11,12]. Cross-linked hyaluronic acid (HA) derivatives are non-permanent dermal fillers used not only for the correction of HIV-LA, but also for treatment of photodamaged skin [13], facial atrophic scars [14] and other cosmetic purposes [15,16,17].…”

“…Most authors assessed patient satisfaction by means of the Global Aesthetic Improvement Scale (GAIS) or the Quality of Life Assessment (QoLA) score [10,11], and only very few attempted to evaluate treatment results in a more objective manner by using ultrasonographic measurements of facial tissues [9,23]. Due to its excellent soft tissue discrimination and the possibility to obtain quantitative data, magnetic resonance imaging (MRI) is increasingly used for the evaluation of injectable dermal fillers [25].…”

Cheekbone and Cheek Area Augmentation with the Briseida Technique: Analysis of 1,000 Cases and 8 Years of Experience

“…The safety and durability of these implants, and their high level of tolerance have already been demonstrated in plenty of studies [3,4,5,6,7,8].…”