A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA).
HIV facial lipoatrophy (FLA) is characterized by facial volume loss. HIV FLA affects the facial contours of the cheeks, temples, and orbits, and is associated with social stigma. Although new highly active antiretroviral therapy medications are associated with less severe FLA, the prevalence of HIV FLA among treated individuals exceeds 50%. The goal of our systematic review is to examine published clinical studies involving the use of filler agents for aesthetic treatment of HIV FLA and to provide evidence-based recommendations based on published efficacy and safety data. A systematic review of the published literature was performed on July 1, 2015, on filler agents for aesthetic treatment of HIV FLA. Based on published studies, poly-L-lactic acid is the only filler agent with grade of recommendation: B. Other reviewed filler agents received grade of recommendation: C or D. Poly-L-lactic acid may be best for treatment over temples and cheeks, whereas calcium hydroxylapatite, with a Food and Drug Administration indication of subdermal implantation, may be best used deeply over bone for focal enhancement. Additional long-term randomized controlled trials are necessary to elucidate the advantages and disadvantages of fillers that have different biophysical properties, in conjunction with cost-effectiveness analysis, for treatment of HIV FLA.
Dermatology Service, Sacramento Department of Veterans Affairs Medical Center, Mather, California; Department of Dermatology, University of California Davis, Sacramento, California; Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York. Electronic address: jrjagdeo@gmail.com.
Jared
J
Jagdeo
Dermatology Service, Sacramento Department of Veterans Affairs Medical Center, Mather, California.
Derek
D
Ho
College of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.
Alex
A
Lo
Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.
Alastair
A
Carruthers
D003357:Cosmetic Techniques; D003362:Cost-Benefit Analysis; D000067548:Dermal Fillers / Q000008:administration & dosage* / Q000191:economics; D004954:Esthetics; D005145:Face; D005260:Female; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D019344:Lactic Acid / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage* / Q000191:economics; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000067548:Dermal Fillers; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)
HIV facial lipoatrophy; HIV lipodystrophy; facial volume loss; filler agent; highly active antiretroviral therapy; quality of life