Surgical Algorithm for Management of HIV Lipodystrophy

Abstract

The authors present an algorithm for treatment of buffalo hump and facial wasting deformities associated with human immunodeficiency virus lipodystrophy syndrome, with an emphasis on long-term results with autogenous tissue.

Once fat was fat and that was that : our changing perspectives on adipose tissue

“…[111][112][113] ADSCs have also been used to treat lipodystrophy, 114 which has become common due to side effects of antiretroviral therapies (ART) in HIV-positive patients. 115,116 These ADSCs are expanded in number in vitro and differentiated into mature adipocytes using a cocktail including insulin, the cAMP inducer IBMX, a PPARg agonist indomethecin and a low concentration of a glucocorticoid such as dexamethasone. 117,118 The use of different cocktails enables ADSCs to be differentiated into osteoblasts, myocytes or chondrocytes.…”

Is buffalo hump fat the perfect filler for facial wasting rehabilitation? Reflection on three cases

“…To restore facial habitus of these patients, several nonabsorbable fillers have been proposed; however, because severe wasting of the buccal fat pad of Bichat, and the hollows of the malar region are particularly deep, these superficially injected fillers may not be adequate to deal with the needs of the patient with severe facial wasting [9]. Side effects, such as foreign body reaction, have also been described, and due to the expense of these products they do not represent the best way to rehabilitate these patients.…”

Comparison Between Lipofilling and a Nonabsorbable Filler for Facial Wasting Rehabilitation in HIV-Positive Patients

“…3 Facial rehabilitation of these patients is challenging and very expensive for the economic national health balance. A noninvasive treatment protocol, such as the cessation of the presumed causative antiretroviral agents, has been proposed, but it showed inconsistent improvement.…”

“…The Journal of Craniofacial Surgery & Volume 22, Number 5, September 2011 the outcomes in using nonabsorbable filler were not so positive as when rehabilitation was performed with lipofilling, probably because, as advocated by Davison et al, 3 severe wasting results from wasting of the buccal fat pad of Bichat, and the hollows of the malar region are also particularly deep, and superficially injected fillers may not adequately address the needs of the patient with severe facial wasting. The use of the peripheral hypertrophied fat, to restore the hypotrophized areas with lipofilling, such as the face, theoretically seems the best option because the costs of nonabsorbable fillers can be avoided; otherwise, because of the longer hospital stay, general anesthesia, and medications costs, this procedure tends to be more expensive than using fillers.…”