title: Psychological morbidity and facial volume in HIV lipodystrophy: quantification of treatment outcome.
abstract: HIV lipoatrophy is a stigmatizing condition associated with significant psychological morbidity. The aim of this study was to evaluate change in facial volume and psychological morbidity following treatment with autologous fat, Sculptra and Bio-alcamid.
  
  
  METHODS
  HIV LD patients were treated based on a clinical assessment in a prospective, observational study. 3-D images were obtained pre-operatively then at 2, 6 and 12 months post-operatively using the DI3D system. Volume changes were measured using DI3D software. The DAS-24 and HADS were used to assess psychological morbidity at similar time intervals.
  
  
  RESULTS
  Forty-eight patients with HIV LD were treated: 16 patients had Bio-alcamid, 20 patients received Sculptra and 12 patients underwent fat transfer. The mean injected volume of Bio-alcamid was 25.5 cc which was comparable to the measured volume change at follow-up. The mean injected volume of fat was 20.1 cc, which did not differ from the measured volumes at 2 months. There was a mean reduction in measured volume change to11.2 cc at 6 months and 10 cc at 12 months. For Sculptra, the mean volume change compared to baseline was 8.7 cc at 2 months, increasing to 12.6 cc at 6 months and 12.3 cc at 12 months. ANOVA tests demonstrated no difference in psychological outcomes between groups. There was a significant improvement in DAS-24 scores compared to baseline for all 3 groups. No correlation between change in facial volume and psychological measures was demonstrated.
  
  
  CONCLUSIONS
  Change in 3-D measured facial volume for all 3 groups was seen. Treatment was associated with improved body image perception.
authors.affiliation: Edinburgh Plastic Surgery Unit, St Johns Hospital, Livingston, Howden Road, West Lothian EH56 6PP, Scotland. drlisanelson@hotmail.com
authors.forename: Lisa
authors.initials: L
authors.lastname: Nelson
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Stewart
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage; D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D001828:Body Image; D002482:Cellulose / Q000008:administration & dosage; D005145:Face / Q000473:pathology*; D005260:Female; D039682:HIV-Associated Lipodystrophy Syndrome / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D021621:Imaging, Three-Dimensional; D019344:Lactic Acid / Q000008:administration & dosage; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D009929:Organ Size; D017060:Patient Satisfaction; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000180:Acrylic Resins; C470344:Bio-Alcamid; C482305:New-Fill; D019344:Lactic Acid; D008353:Mannitol; D002482:Cellulose