Injection of synthetic polymer may improve facial wasting syndrome associated with HIV

Facial injections of polylactic acid, a synthetic biodegradable polymer, may help improve the debilitating facial lipoatrophy (loss of fat in the face) associated with HIV infection and its treatment, according to an article in the March issue of Archives of Dermatology, one of the JAMA/Archives journals.

Advances in treatments for HIV, including combination antiretroviral therapy, have enabled patients with the disease to live longer and healthier lives, according to background information in the article. Because of their longer lifespans, some patients with HIV are now experiencing additional complications. Changes in body fat distribution, including loss of subcutaneous fat in the face, may be a side effect of antiretroviral therapy and affect somewhere between 10 and 62 percent of individuals with HIV, the authors write. This facial lipoatrophy or facial wasting may lead to anxiety, depression, self-image problems and difficulties in social or sexual relationships.

Anna Maria Cattelan, M.D., University of Padua, Italy, and colleagues studied the efficacy, safety and tolerability of polylactic acid injections on 50 HIV¬–¬¬infected patients (42 men, 8 women) with moderate to severe facial lipoatrophy who visited an outpatient clinic between January and June 2002. Participants were given a full physical examination and questionnaire about the degree of their facial lipoatrophy and their overall health status when they enrolled in 2002. Facial photographs were taken and they underwent ultrasound evaluation, which recorded the thickness of the skin over their cheeks. The researchers then administered four sets of injections at the beginning of the study and again after 30, 45 and 60 days. The 16 patients with the most severe facial wasting received two additional injections after 75 and 90 days.

The patients' facial atrophy began to improve after the second injection and remained visibly improved through the end of the follow-up period (12 months). Twelve months after the end of the treatment period, the total thickness of skin and fat increased an average of 3.4 millimeters over the right cheek and 3.3 millimeters over the left cheek. More than half of the patients had rated their facial lipoatrophy as severe at the beginning of the study; after finishing treatment none did so, and 12 months later two patients (4 percent) rated their condition as severe and more than half rated it as absent to moderate. Fifteen (30 percent) of the participants experienced adverse reactions to the injections, but none were severe and none interrupted treatment because of them. Questionnaire results also revealed an improvement in self-perceptions of well-being after treatment.

"The results of our study show that the correction of facial lipoatrophy with polylactic acid applications is safe and effective in increasing dermal thickness after a complete cycle of four to six injections, with a durability of response lasting until month 12 of follow-up," the authors conclude. "These benefits were confirmed by ultrasonographic study, with a significant increase in dermal thickness that persisted at 36 to 40 weeks after the last injection. …Our patients did not need either hospitalization or chemoprophylaxis [preventive medications] and were treated using an outpatient regimen, without affecting their daily activity."

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(Arch Dermatol. 2006; 142:329-334. Available pre-embargo to the media at www.jamamedia.org.)

Editors Note: This study was supported in part by a grant from Azienda Ospedaliera di Padova, Padua, Italy.


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