Use of polylactic acid implants to correct facial lipoatrophy in human immunodeficiency virus 1-positive individuals receiving combination antiretroviral therapy.
OBJECTIVE
To assess the efficacy, safety, and tolerability of facial injections of polylactic acid for human immunodeficiency virus (HIV) 1-associated facial lipoatrophy, which commonly affects HIV-1-infected patients receiving combination antiretroviral therapy.


METHODS
A cohort of 50 consecutive HIV-1-infected outpatients with moderate to severe facial lipoatrophy who were receiving antiretroviral therapy were recruited in one institutional center and followed up for 12 months. Patients received the compound subcutaneously at baseline and on days 30, 45, and 60 of the study, for a total of 4 sets of injections; if necessary, 2 additional sets of injections were allowed on days 75 and 90. At enrollment and during follow-up, data on patients' characteristics, facial ultrasonography, and iconography were assessed. Data for 2 questionnaires, on self-perception of severity of facial lipoatrophy and on quality of life measured by the Medical Outcomes Study-HIV, were also obtained.


RESULTS
Polylactic acid injections led to a significant improvement in facial lipoatrophy, confirmed by the patients' facial lipoatrophy self-perception and by the ultrasonographic evaluation. The mean total cutaneous thickness of each cheek increased significantly between baseline and after completing the polylactic acid injection sessions (4.3 mm [range, 2.7-6.2 mm] [P<.001] and 4.4 mm [range, 2.7-6.1 mm] [P<.001] on the right and left cheeks, respectively) and persisted significantly until month 12 of follow-up (3.4 mm [range, 2.3-4.9 mm] [P<.001] and 3.3 mm [range, 1.6-5.0 mm] [P<.001] on the right and left cheeks, respectively). In addition, a significant (P<.01) improvement in overall quality of life was observed between baseline and the end of the study. No patients discontinued treatment because of toxic effects, and subcutaneous micronodules at the site of injection were never observed.


CONCLUSIONS
Polylactic acid injections can be considered an effective, safe, and simple procedure in HIV-related facial lipoatrophy. The overall improvement of quality of life was clearly associated with the correction of lipoatrophy, reflecting the positive effect of this strategy on patient well-being.
Cattelan
Anna Maria
AM
Department of Infectious Diseases, Unit of Radiology, General Hospital and University of Padua, Via Giustiniani 2, 35128 Padua, Italy. amcattelan@libero.it
Bauer
Ute
U
Trevenzoli
Marco
M
Sasset
Lolita
L
Campostrini
Stefano
S
Facchin
Chiara
C
Pagiaro
Emilio
E
Gerzeli
Stefano
S
Cadrobbi
Paolo
P
Chiarelli
Angelo
A
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D001672:Biocompatible Materials; D004359:Drug Therapy, Combination; D005145:Face; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000628:therapy*; D006801:Humans; D019344:Lactic Acid / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage*; D019736:Prostheses and Implants
D044966:Anti-Retroviral Agents; D001672:Biocompatible Materials; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)