Safety and Efficacy of a Volumizing Hyaluronic Acid Filler for Treatment of HIV-Associated Facial Lipoatrophy.

Importance: Facial lipoatrophy (FLA) is associated with human immunodeficiency virus (HIV) disease and the use of highly active antiretroviral therapy. The condition is primarily characterized by facial volume loss that affects the contours of the cheeks, temples, and orbits and may negatively affect patients' adherence to highly active antiretroviral therapy, psychological health, and quality of life. A single treatment of hyaluronic acid (HA) filler, 20 mg/mL, may provide an immediate, natural-appearing facial enhancement outcome. Objective: To evaluate the safety and efficacy of an HA filler for treatment of HIV-associated FLA during a 12-month follow-up. Design, Setting, and Participants: Open-label, safety and efficacy study in patients with HIV-associated FLA, a Carruthers Lipoatrophy Severity Scale (CLSS) grade of 2 or greater (range, 1-4, with higher scores indicating greater severity), and no previous treatment for FLA during the past year received 1 treatment and an optional touch-up. Twenty patients were treated and followed up at the Sacramento Veterans Affairs Medical Center, Mather, California, from March 5, 2015, to May 17, 2016. Interventions: Midface (cheeks and temples) volumization was performed using the "smile-and-fill," fanning, and depot technique with an optional touch-up at the 2-week follow-up. Main Outcomes and Measures: Patients underwent evaluation at the initial visit and follow-up at 2 weeks and 3, 6, 9, and 12 months. Main outcome measures included safety (rate of treatment-related adverse events), CLSS grade, and Global Aesthetic Improvement Scale rating (5-point scale, ranging from worse to very much improved). Results: Nineteen of the 20 patients (all men; mean [SD] age, 57 [10] years) completed all study visits. Baseline HIV-associated FLA severity was CLSS grade 2 in 16 patients; grade 3, in 3 patients; and grade 4, in 1 patient. The total mean (SD) volume of HA used was 6.1 (3.1) mL for grade 2 FLA; 9.3 (4.2) mL for grade 3 FLA; and 26.0 (0) mL for grade 4 FLA (1 mL equals 1 syringe of HA filler). All 19 patients maintained a significant improvement of CLSS (grade 1) and Global Aesthetic Improvement Scale rating (very much improved) with no treatment-related adverse events at 12 months. Conclusions and Relevance: This study reports excellent safety and efficacy and supports use of this HA filler for treatment of HIV-associated FLA with durable results at 12 months. Future multicenter, randomized clinical trials with blinded independent investigators are needed to demonstrate the long-term safety, efficacy, and durability of this HA filler for treatment of HIV-associated FLA.

5-year study of a polyacrylamide hydrogel-based filler for rehabilitation of HIV-related facial lipoatrophy.

BACKGROUND: Lipoatrophy of the face negatively impacts the quality of life and body image of individuals on antiretroviral therapy. Facial fillers can minimize the stigma associated with the human immonodeficiency virus (HIV). OBJECTIVES: In this 5-year follow-up study, the author assessed the safety and efficacy of a permanent, non-biodegradable, polyacrylamide hydrogel for facial volume restoration, and compared the results with those of a previous 18-month follow-up study. METHODS: Thirty-one HIV-positive individuals, initially enrolled in the study between January 2008 and January 2009, received treatment of facial wasting by injection of the polyacrylamide gel until complete volume restoration was achieved. Asepsis rules were strictly observed before and during each injection session. Patients evaluated their aesthetic outcomes on a visual analog scale. RESULTS: Patient satisfaction was high. There was no occurrence of local infection, foreign-body reaction, or product during the 5 years of follow-up. Small, palpable, nonvisible nodules were recorded in nine cases. It appears that these same nodules were present in the 18-month study. It is believed that the nodules were caused by overfilling in the same site. CONCLUSIONS: As supported by the initial 18-month study, polyacrylamide hydrogel filler appears safe and effective for the treatment of HIV-related lipoatrophy. With strict observation of asepsis rules and patient adherence to posttreatment instructions, this filler can be ideal for treating facial wasting in patients with HIV. LEVEL OF EVIDENCE: 3 Therapeutic.

Morphology and biochemical markers of people living with HIV/AIDS undergoing a resistance exercise program: clinical series.

This descriptive case study aimed at assessing body's composition and impact on biochemical markers of people living with HIV/AIDS (S1=male-1, S2=female-1) undergoing a four-month intervention program of resistance exercises. Was analyzed the lipid profile (total cholesterol, LDL, HDL and triglycerides serum), immunological parameters (CD4 and viral load/VL) and morphological parameters (body mass index BMI, waist/Hip/WHR, perimeters and skinfold). Blood samples and antropometric measures were obtained in the pre-exercise (pre-test) and immediately after (16 weeks) of exercise (post-test). An increase in HDL (38 pre, 42 post), LDL (89.6 pre, 95 post) was noted for S1 and a decrease in HDL (33 pre, 25 post) and LDL (121.6 pre, 121 post) for S2; a decrease in Triglyceride for S1 (292 pre, 214 post) and increase for S2 (102 pre, 166 post). Total cholesterol increased for both subjects (186 pre, 261 post S1 and 175 pre, 179 post S2). there was a decrease in CD4 for S1 (598 pre, 577 post) and an increase for S2 (748 pre, 1.071 post). With respect to viral load, we found that both subjects (S1 and S2) presented values below the minimum limit (pre and post test), with no significant changes. Body composition improved (LMpre S1=43.13% and S2=23.35% and LMpost S1=46.51 and S2=26.15%; BFpre S1=41.13 and S2=18.14% and BFpost S1=38.32 and S2=14.77%), as did BMI (25.27 pre, 27.44 post S1) and (24.24 pre, 24.74 post S2). The resistance exercise program as base in this intervention model promoted a healthy state for HIV and AIDS patients and did not pose any health risks to them.

Poly-L-lactic acid: a new dimension in soft tissue augmentation.

Poly-L-lactic acid (PLLA) is a biodegradable, synthetic polymer of L-lactic acid that has been used in a variety of human medical applications for over 40 years. It has recently been approved in the United States for the treatment of HIV-associated facial lipoatrophy. This indication, combined with a European experience that indicates a clinical benefit persisting for up to 2 years, has made PLLA an increasingly popular injectable soft tissue filler in healthy patients. However, controlled clinical studies are necessary to determine whether PLLA benefits healthy patients seeking contour restoration as much as patients seeking treatment for HIV facial lipoatrophy. The present authors reviewed the background and clinical applications of PLLA as treatment for HIV-associated facial lipoatrophy and age-related facial volume loss.