title: Semipermanent filler treatment of HIV-positive patients with facial lipoatrophy: long-term follow-up evaluating MR imaging and quality of life.
abstract: BACKGROUND
  Injectable fillers such as poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) have shown promising results in the treatment of combination antiretroviral therapy (cART)-induced facial lipoatrophy (FLA). However, the effects of these substances on magnetic resonance imaging (MRI) have not yet been described.
  
  
  OBJECTIVE
  The authors analyze the association between the effects of treatment with semipermanent fillers on MRI and changes in quality of life (QOL).
  
  
  METHODS
  Eighty-two human immunodeficiency virus (HIV)-positive patients with cART-induced FLA (grades 2-4) were enrolled in this prospective study. A mean volume of 58.2 mL (range, 12-105 mL) of PLLA (n = 41 patients) and 9.1 mL (range, 3-23 mL) of CaHA (n = 41) was injected in multiple sessions. The MRI examinations were performed prior to treatment and again 12 months after. The self-reported severity of FLA as well as QOL was measured using questionnaires based on Short Form 36, Medical Outcomes Study HIV Health Survey, and Center for Epidemiologic Studies Depression Scale formats.
  
  
  RESULTS
  Significant increases in total subcutaneous thickness (TST) of the injected regions could be identified on MRI in nearly all patients 1 year posttreatment. Patients reported that mental health and social and role functioning improved; depressive symptoms decreased after treatment. In addition, the increase in TST was positively associated with improvement of QOL.
  
  
  CONCLUSIONS
  This study confirms that treatment with both PLLA and CaHA not only increases TST but also is associated with improved QOL for HIV-infected patients. Furthermore, the study also demonstrates that MRI can show filler-induced neocollagenesis and quantify FLA treatment effects.
authors: Dr van Rozelaar is a cosmetic medical practitioner in private practice in Amsterdam, the Netherlands.
authors: Leo
authors: L
authors: van Rozelaar
authors: Jonathan A
authors: JA
authors: Kadouch
authors: Debbie A
authors: DA
authors: Duyndam
authors: Pythia T
authors: PT
authors: Nieuwkerk
authors: Femke
authors: F
authors: Lutgendorff
authors: Refaat B
authors: RB
authors: Karim
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage* / Q000009:adverse effects; D003357:Cosmetic Techniques / Q000009:adverse effects; D017886:Durapatite / Q000008:administration & dosage* / Q000009:adverse effects; D005145:Face; D005260:Female; D006679:HIV Seropositivity; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis / Q000523:psychology / Q000628:therapy* / Q000821:virology; D006801:Humans; D007279:Injections, Subcutaneous; D019344:Lactic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D050151:Subcutaneous Fat / Q000473:pathology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide); D017886:Durapatite
keywords: HIV; MRI; combination antiretroviral therapy; cosmetic medicine; facial; fillers; lipoatrophy; quality of life