title: Retreatment with injectable poly-l-lactic acid for HIV-associated facial lipoatrophy: 24-month extension of the Blue Pacific study.
abstract: BACKGROUND
  Facial lipoatrophy occurs in HIV-positive patients taking highly active antiretroviral therapy and during natural aging. Injectable poly-l-lactic acid (PLLA) is a device approved internationally for restoration and correction of the signs of HIV-associated facial lipoatrophy.
  
  
  OBJECTIVE
  To evaluate the long-term safety, duration of effect, and satisfaction with serial injections of PLLA for HIV-associated facial lipoatrophy.
  
  
  METHODS
  In this single-site, open-label, retreatment study, 65 HIV-positive patients were treated with injectable PLLA every 5 weeks (until optimal recorrection). Presenting degree of lipoatrophy based on the James scale (1=mild, 4=severe) was reviewed. Skin thickness was measured at fixed points with calipers. Patients completed a post-retreatment satisfaction questionnaire.
  
  
  RESULTS
  Nearly 10% of patients had persistent correction >36 months, based on patient report. Approximately 50% required three or fewer retreatments to maintain satisfactory correction (determined by patient and physician). Milder lipoatrophy on initial presentation required fewer retreatments and had more sustained correction. Time to first retreatment varied according to James scale score: 1 (21.4 months) and 4 (13.0 months). The mean patient satisfaction score was 4.9 (1=dissatisfied, 5=very satisfied) at study end. No serious adverse events were reported.
  
  
  CONCLUSIONS
  Injectable PLLA is a safe and effective long-term treatment option for HIV-associated lipoatrophy.
authors.affiliation: Blue Pacific Aesthetic Medical Group, Inc., El Segundo, California 90245, USA. DRMEST@aol.com
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Mest
authors.forename: Gail M
authors.initials: GM
authors.lastname: Humble
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage; D003357:Cosmetic Techniques; D005260:Female; D005500:Follow-Up Studies; D039682:HIV-Associated Lipodystrophy Syndrome / Q000145:classification / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007271:Injections, Intradermal; D019344:Lactic Acid / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage*; D019736:Prostheses and Implants; D019233:Retreatment
chemical_list: D001672:Biocompatible Materials; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)