Comparison of three different interventions for the correction of HIV-associated facial lipoatrophy: a prospective study.
OBJECTIVE
To compare autologous fat transfer (AFT), injections of reabsorbable [polylactic acid (PLA)] and non-reabsorbable [polyacrylamide hydrogel (PAAG)] filler materials for the treatment of HIV-related facial lipoatrophy.


METHODS
Eligible individuals with enough residual subcutaneous fat in the abdomen or in the dorso-cervical region were offered AFT surgery. Other individuals were blindly assigned to two different surgical teams, who administered a set of PLA or PAAG injections every 4 weeks. The primary endpoint was the measurement of Bichat's fat pad region, determined by the result of dermal plus subcutaneous thickness. Secondary endpoints included body image evaluation (determined by ABCD questionnaire), facial aesthetic satisfaction (determined by Visual Analogue Scale), and aesthetic pre- and post-picture comparisons by independent reviewers. All variables were measured at baseline and at 24 weeks after the last treatment session.


RESULTS
Twenty-four individuals received AFT and 35 were selectively randomized to PLA (20) or PAAG (15) infiltrations. PLA and PAAG groups received a mean of 5 and 6 injections respectively (P = NS). The mean change in dermal and subcutaneous thickness was 3.3 +/- 4.1 mm, 3.5 +/- 4.0 mm; 2.1 +/- 3.0 mm (P = 0.687), respectively. The mean change in ABCD score result was poorer in the AFT arm, but there were no other differences in other measured factors. Four serious adverse events were documented in the AFT arm only.


CONCLUSIONS
All three interventional techniques were highly effective in improving the aesthetic satisfaction of the patients. Longer follow-up is necessary to determine the most durable and suitable treatment.
Guaraldi
Giovanni
G
HIV Metabolic Clinic, Department of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Italy. g.guaraldi@unimo.it
Orlando
Gabriella
G
De Fazio
Domenico
D
De Lorenzi
Ilario
I
Rottino
Antonio
A
De Santis
Giorgio
G
Pedone
Antonio
A
Spaggiari
Antonio
A
Baccarani
Alessio
A
Borghi
Vanni
V
Esposito
Roberto
R
D000180:Acrylic Resins / Q000008:administration & dosage*; D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D005148:Facial Dermatoses / Q000188:drug therapy / Q000601:surgery; D005260:Female; D015658:HIV Infections / Q000150:complications*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007271:Injections, Intradermal; D019344:Lactic Acid / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage*; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D000180:Acrylic Resins; D011091:Polyesters; D011108:Polymers; C016680:polyacrylamide gels; D019344:Lactic Acid; C033616:poly(lactide)