Treatment of Facial Lipoatrophy With Intradermal Injections of Polylactic Acid in HIV-Infected Patients

Lafaurie, Matthieu; Dolivo, M; Porcher, Raphaël; Rudant, Jérémie; Madelaine, Isabelle; Molina, Jean‐Michel

doi:10.1097/01.qai.0000152834.02912.98

Cited by 71 publications

(83 citation statements)

References 18 publications

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“…16 However, these treatment options have been limited by incomplete recovery of fat loss several years after discontinuation of stavudine 17 or are not long lasting as in the case of injectables. 18 Factors other than antiretroviral drugs including CD4 nadir, older age, and HIV infection itself have also been implicated. 4,9,19,20 The varying definitions used to describe the syndrome in different studies may partly explain the differences in the factors, particularly antiretroviral drug therapies, associated with fat changes.…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral Therapies Associated with Lipoatrophy in HIV-Infected Women

Tien

Barrón

Justman

et al. 2007

AIDS Patient Care and STDs

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We previously demonstrated that HIV infection is associated with peripheral and central lipoatrophy in women. We now describe the association of specific antiretroviral drugs (ARV) with body fat changes over a four-year period from 1999 to 2003. 775 HIV-positive and 205 HIVnegative women in the Women's Interagency HIV Study with anthropometric measurements, weight, bioelectric impedance analysis and ARV collected semiannually were included in analysis. Exposure to ARV was defined as report of use for 3 consecutive semiannual study visits. The average 6-month change in weight, percent total body fat, and circumference measurements (i.e., hip, waist, chest, arm, and thigh) was compared between those exposed and those unexposed to the specific ARV for any of the same three consecutive visits. Weight, percent total body fat, and hip, waist, thigh, chest, and arm circumferences decreased in HIV-positive women, but increased in HIV-negative women on average for every six-month interval over the 4-year study period. Among the HIV-positive women, didanosine was the only ARV associated with decreases in circumference measures in the hip (−0.65 cm, 95% confidence interval [CI]: −1.18, −0.12), waist (−0.71 cm, 95% CI: −1.37, −0.04), chest (−0.71 cm, 95% CI: −1.17, −0.26), and arm (−0.23 cm, 95% CI: −0.48, 0.03; p = 0.08). These prospective data suggest that fat loss continues to predominate in HIV-positive women and exposure to didanosine for at least 12 months may further worsen fat loss.

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Section: Introductionmentioning

confidence: 99%

Antiretroviral Therapies Associated with Lipoatrophy in HIV-Infected Women

Tien

Barrón

Justman

et al. 2007

AIDS Patient Care and STDs

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“…These changes, while lower than the week 48 changes reported in some studies [9,11,17], are comparable to those reported in others [13,14]. However, cross-study comparisons of PLA efficacy for HIV facial lipoatrophy are problematic because of the heterogeneity of these studies.…”

Section: Discussionmentioning

confidence: 52%

“…Although open-label studies have demonstrated PLA safety in HIV-infected adults [9][10][11][12][13][14][15][16][17][18], PLA efficacy has been objectively assessed in only one randomized clinical trial [19]. This open-label, multicentre study compared immediate vs. deferred PLA injections in adults with moderate to severe facial lipoatrophy.…”

Section: Introductionmentioning

confidence: 99%

Poly‐l‐lactic acid for HIV‐1 facial lipoatrophy: 48‐week follow‐up

Carey¹,

Baker²,

Petoumenos³

et al. 2009

HIV Medicine

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ObjectivesPoly-L-lactic acid (PLA) injections modestly increase objectively assessed facial thickness but not facial soft tissue volume (FSTV) over 24 weeks. The durability of this response has not been well defined objectively. MethodsHIV-infected lipoatrophic adults were randomized to four open-label PLA treatments administered every 2 weeks from week 0 (immediate group, n 5 50) or from week 24 (deferred group, n 5 50). Endpoints included FSTV assessed by computed tomography, facial lipoatrophy severity, quality of life (QoL) and safety. Analyses were by intention to treat. ResultsBetween weeks 24 and 48, soft tissue thickness increased modestly in injection planes, at the maxillary [mean 0.9 mm; 95% confidence interval (CI) 0.3-1.5 mm; P 5 0.007] and base of nasal septum levels (mean 0.4 mm; 95% CI 0.1-0.8; P 5 0.021), but not in untreated areas (P 5 0.79 and P 5 0.24). PLA durability assessed at week 48 in immediate group participants showed a mean change in FSTV of 14 cm 3 (95% CI À1 to 29 cm 3 ; P 5 0.060) and increased tissue depth at the maxillary (Po0.0001), base of nasal septum (Po0.0001) and mandibular (P 5 0.0035) levels. At week 48, clinicians and patients subjectively assessed facial lipoatrophy severity as reduced in immediate participants (83 and 91%, respectively), and the Mental Health scale score of the Short Form-36 Health Survey improved significantly in immediate participants relative to deferred participants (P 5 0.027). Subcutaneous injection-site nodule incidence at 48 weeks was 10%. ConclusionsPLA treatment benefits were durable, with objectively assessed modest increases in facial volume and tissue thickness sustained over 48 weeks in injection planes but not in other facial areas. Improvements in some QoL domains were maintained. IntroductionLipoatrophy of subcutaneous adipose tissue in the limbs, face and buttocks, and accumulation of adipose tissue in the intra-abdominal space, dorsocervical region and the breasts are major features of HIV lipodystrophy [1,2].Facial lipoatrophy, the most distressing manifestation, can be stigmatizing, severely affecting quality of life (QoL) and self-esteem, and may result in reduced antiretroviral (ARV) adherence [3]. Although use of the newer nonthymidine nucleoside reverse transcriptase inhibitors is associated with less lipoatrophy [4], in the absence of proven therapies, management of established fat loss can be challenging as reversal is slow [5][6][7].An array of injectable filling agents has been marketed for soft tissue augmentation and many of these are used for aesthetic management of HIV facial lipoatrophy [8]. Methods ParticipantsDetails of participants' eligibility, randomization and baseline characteristics have been reported previously in the 24-week primary efficacy comparison [19]. All participants provided written, informed consent following approval by the local human research ethics committee at each site. InterventionsAt baseline, 100 eligible patients were randomized to receive four open-label PLA treatments [one vial (150 m...

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“…The volumes used in our patients were therefore very similar to those used in adult studies. Other fillers, preferably bioabsorbable, such as collagen, hyaluronic acid and polylactic acid, have also been used in HIV-infected adult patients [28][29][30][31]. However, Treating lipoatrophy in HIV-infected adolescents 265 these treatments involve repeated injections, and long-term tolerance of 'foreign' material is not known.…”

Section: Discussionmentioning

confidence: 99%

Correction of facial lipoatrophy using autologous fat transplants in HIV‐infected adolescents

et al. 2009

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Objectives Antiretroviral therapy has dramatically improved the survival of HIV‐infected children. Nevertheless, side effects comparable to those found in adults have been encountered, such as facial lipoatrophy, which can have a negative impact on the self‐esteem of otherwise healthy adolescents. Cosmetic surgical procedures in adolescents raise psychological issues which need to be specifically addressed and which have never been previously reported in this population. We evaluated the patient satisfaction, safety and cosmetic results of HIV‐infected adolescents who experienced autologous fat transplants for the correction of facial lipoatrophy. Methods We report the results of plastic surgery using autologous fat transplants (Coleman's Lipostructure™) in six HIV‐infected adolescents with facial lipoatrophy: three boys and three girls, aged 14–19 years. Results The quantity of reinjected fat on each side of the face varied from 5 to 12 mL within a single procedure. All the patients reported being satisfied or very satisfied with the cosmetic results and reported a positive impact on their daily life. Conclusions With well‐trained surgeons and carefully selected indications, corrective surgery of facial lipoatrophy in HIV‐infected adolescents can provide immediate and long‐lasting benefits in terms of physical appearance and psychological wellbeing, and should be considered as a component of comprehensive care.

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Treatment of Facial Lipoatrophy With Intradermal Injections of Polylactic Acid in HIV-Infected Patients

Abstract: Injections of PLA improved patients' self-perception of facial lipoatrophy, with a good safety profile. The benefit of the procedure, however, decreased with time.

Cited by 71 publications

References 18 publications

Antiretroviral Therapies Associated with Lipoatrophy in HIV-Infected Women

Antiretroviral Therapies Associated with Lipoatrophy in HIV-Infected Women

Poly‐l‐lactic acid for HIV‐1 facial lipoatrophy: 48‐week follow‐up

Correction of facial lipoatrophy using autologous fat transplants in HIV‐infected adolescents

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