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Use of Polylactic Acid Implants to Correct Facial Lipoatrophy in Human Immunodeficiency Virus 1–Positive Individuals Receiving Combination Antiretroviral Therapy
Anna Maria Cattelan, MD;
Ute Bauer, MD;
Marco Trevenzoli, MD;
Lolita Sasset, MD;
Stefano Campostrini, PhD;
Chiara Facchin, MD;
Emilio Pagiaro, MD;
Stefano Gerzeli, PhD;
Paolo Cadrobbi, MD;
Angelo Chiarelli, MD
Arch Dermatol. 2006;142:329-334.
Objective To assess the efficacy, safety, and tolerability of facial injections of polylactic acid for human immunodeficiency virus (HIV) 1–associated facial lipoatrophy, which commonly affects HIV-1–infected patients receiving combination antiretroviral therapy.
Design A cohort of 50 consecutive HIV-1–infected outpatients with moderate to severe facial lipoatrophy who were receiving antiretroviral therapy were recruited in one institutional center and followed up for 12 months. Patients received the compound subcutaneously at baseline and on days 30, 45, and 60 of the study, for a total of 4 sets of injections; if necessary, 2 additional sets of injections were allowed on days 75 and 90. At enrollment and during follow-up, data on patients' characteristics, facial ultrasonography, and iconography were assessed. Data for 2 questionnaires, on self-perception of severity of facial lipoatrophy and on quality of life measured by the Medical Outcomes Study–HIV, were also obtained.
Results Polylactic acid injections led to a significant improvement in facial lipoatrophy, confirmed by the patients' facial lipoatrophy self-perception and by the ultrasonographic evaluation. The mean total cutaneous thickness of each cheek increased significantly between baseline and after completing the polylactic acid injection sessions (4.3 mm [range, 2.7-6.2 mm] [P<.001] and 4.4 mm [range, 2.7-6.1 mm] [P<.001] on the right and left cheeks, respectively) and persisted significantly until month 12 of follow-up (3.4 mm [range, 2.3-4.9 mm] [P<.001] and 3.3 mm [range, 1.6-5.0 mm] [P<.001] on the right and left cheeks, respectively). In addition, a significant (P<.01) improvement in overall quality of life was observed between baseline and the end of the study. No patients discontinued treatment because of toxic effects, and subcutaneous micronodules at the site of injection were never observed.
Conclusions Polylactic acid injections can be considered an effective, safe, and simple procedure in HIV-related facial lipoatrophy. The overall improvement of quality of life was clearly associated with the correction of lipoatrophy, reflecting the positive effect of this strategy on patient well-being.
Author Affiliations: Department of Infectious Diseases (Drs Cattelan, Trevenzoli, Sasset, Facchin, and Cadrobbi), Unit of Radiology (Dr Pagiaro), and Departments of Plastic Surgery and Dermatology (Drs Bauer and Chiarelli) and Infectious Diseases (Dr Pagiaro), General Hospital and University of Padua, Padua; and Department of Applied Statistics and Economics, University of Pavia, Pavia (Drs Campostrini and Gerzeli), Italy.
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