title: An index for staging facial lipoatrophy and evaluation of the efficacy of the treatment with polymethylmethacrylate in HIV/AIDS patients: a pilot study.
abstract: BACKGROUND
  Treatment of facial lipoatrophy of HIV/AIDS patients is mandatory by law in Brazil due to its negative impact on their quality of life. The index for facial lipoatrophy (ILA) is used as one of the inclusion criteria for patient treatment.
  
  
  OBJECTIVE
  To define a correct diagnosis and staging of facial lipoatrophy, by employing the ILA.
  
  
  METHODS
  This is an observational study of a series of case reports from patients submitted to facial lipoatrophy evaluation through ILA and treated with polymethylmethacrylate (PMMA) fillers. Facial lipoatrophy was classified in grades from I to IV, corresponding to mild, moderate, severe and very severe stage, according to ILA. Response to the treatment was defined as excellent (≥ 91%), good (71-90%), moderate (51-70%) and insufficient (≤ 50%).
  
  
  RESULTS
  A total of 20 patients were included in this study: 18 men and two women. Median age was 49 years (35-61) and average ILA was 9.9 (7.2-16.8). Ten patients presented facial lipoatrophy grade II (moderate), 5 grade III (severe) and 5 grade IV (very severe). The average volume of PMMA used was 13 mL (5.5-22 mL). All patients showed good or excellent response, with a median of 86% (74-100%). The most typical adverse effect was local oedema but there were no late adverse effects.
  
  
  CONCLUSIONS
  The ILA is an excellent method for evaluation of facial lipoatrophy and also for the assessment of the response to therapy. Facial filling with PMMA showed efficacy and safety in the treatment of facial lipoatrophy in HIV/AIDS patients.
authors: Sector of Dermatology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. drmarcio@clinicamarcioserra.com.br
authors: M S
authors: MS
authors: Serra
authors: L K
authors: LK
authors: Oyafuso
authors: B M
authors: BM
authors: Trope
authors: O H
authors: OH
authors: Munhoz Leite
authors: M
authors: M
authors: Ramos-e-Silva
mesh_terms: D000328:Adult; D005145:Face; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008060:Lipodystrophy / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019904:Polymethyl Methacrylate