Treatment of facial lipoatrophy with intradermal injections of polylactic acid in HIV-infected patients.
BACKGROUND
This study assessed the safety and efficacy of intradermal injections of polylactic acid (PLA) in patients with facial lipoatrophy under antiretroviral therapy.


METHODS
In a prospective open-label study, PLA was injected in both cheeks every 2 weeks. The primary efficacy endpoint was the patient's self-perception of improvement as assessed by a visual analogue scale (VAS). Secondary endpoints included 3-dimensional photographs (3DP) to measure dermal thickness, quality of life (QoL) scores, and adverse events.


RESULTS
Ninety-four patients received a median of 5 sets of injection in both cheeks. Median age was 43 years, and median CD4 cell count was 500/mm3. Median VAS score significantly increased from 3.4/10 at baseline to 6.8/10 at the end of the treatment procedure and was sustained at 7/10 at the end of follow-up (P < 0.0001 vs. baseline). Median dermal thickness increase was 2.3 mm at the end of follow-up. QoL scores remained unchanged. Seventeen patients needed further injections of PLA during a median follow-up of 12 months. Injections were well tolerated with only 1 serious adverse event (anaphylactic reaction) that necessitated treatment interruption.


CONCLUSIONS
Injections of PLA improved patients' self-perception of facial lipoatrophy, with a good safety profile. The benefit of the procedure, however, decreased with time.
Lafaurie
Matthieu
M
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris, France.
Dolivo
Marc
M
Porcher
Raphäel
R
Rudant
Jérémie
J
Madelaine
Isabelle
I
Molina
Jean-Michel
JM
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005148:Facial Dermatoses / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000188:drug therapy*; D006801:Humans; D007271:Injections, Intradermal; D019344:Lactic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors
D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)