HIV lipoatrophy is a stigmatizing condition associated with significant psychological morbidity. The aim of this study was to evaluate change in facial volume and psychological morbidity following treatment with autologous fat, Sculptra® and Bio-alcamid®.
HIV LD patients were treated based on a clinical assessment in a prospective, observational study. 3-D images were obtained pre-operatively then at 2, 6 and 12 months post-operatively using the DI3D system. Volume changes were measured using DI3D software. The DAS-24 and HADS were used to assess psychological morbidity at similar time intervals.
Forty-eight patients with HIV LD were treated: 16 patients had Bio-alcamid®, 20 patients received Sculptra® and 12 patients underwent fat transfer. The mean injected volume of Bio-alcamid® was 25.5 cc which was comparable to the measured volume change at follow-up. The mean injected volume of fat was 20.1 cc, which did not differ from the measured volumes at 2 months. There was a mean reduction in measured volume change to11.2 cc at 6 months and 10 cc at 12 months.
For Sculptra®, the mean volume change compared to baseline was 8.7 cc at 2 months, increasing to 12.6 cc at 6 months and 12.3 cc at 12 months.
ANOVA tests demonstrated no difference in psychological outcomes between groups. There was a significant improvement in DAS-24 scores compared to baseline for all 3 groups. No correlation between change in facial volume and psychological measures was demonstrated.
Change in 3-D measured facial volume for all 3 groups was seen. Treatment was associated with improved body image perception.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Pathogenesis of HIV-1-protease inhibitor-associated peripheral lipodystrophy, hyperlipidaemia, and insulin resistance.Lancet. 1998; 351: 1881-1883
- S E. HIV lipodystrophy: prevalence, severity and correlates of risk in Australia.HIV Med. 2003; 4: 293-301
- Body habitus changes relating to lipodystrophy.Clin Infect Diseases. 2003; 36: 84-90
- An objective lipodystrophy severity grading scale derived from the lipodystrophy case definition score.J Acquire Immun Def Syndrom. 2003; 33: 571-576
- Psychological impact of lipodystrophy syndrome in HIV infection.AIDS Reader. 2000; 10: 546-551
- Anxiety and self-conciousness in patients with minor facial lacerations.J Adv Nursing. 2004; 47: 417-426
- Treatment of facial fat atrophy related to treatment with proteast inhibitors by autologous fat injection in patients with Human Immunodeficiency Virus infection.Plas Recon Surg. 2004; 114: 551-555
- Treatment of facial fat atrophy related to treatment with protease inhibitors by autologous fat injection in patients with Human Immunodeficiency Virus infection.Plas Recon Surg. 2004; 114: 556-558
- Caporale. Bio-alcamid in drug-induced lipodystrophy.J Cosmetic Laser Ther. 2003; 5: 226-230
- Bio-alcamid: an electron microscopic study after skin implantation.Plas Recon Surg. 2004; 113: 1104-1106
- Bio-alcamid, a novel prosthetic polymer, does not interfere with morphological and functional characteristics of human skin fibroblasts.Plas Recon Surg. 2003; 111: 489-491
- Experience with Bio-alcamid, a new soft tissue endoprosthesis.JPRAS. 2007; 60: 663-667
- Preliminary experiences with Bio-alcamid in HIV facial lipoatrophy.Dermatology. 2007; 214: 151-154
- Polylactic acid implants (Newfill) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA.AIDS. 2003; 17: 2471-2477
- A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection.HIV Med. 2004; 5: 82-87
- Safety and efficacy of poly-L-lactic acid injections in persons with HIV-associated lipoatrophy: the US experience.Dermatol Surg. 2006; 32: 1336-1345
- The hospital anxiety and depression scale.Acta Psych Scand. 1983; 67: 361-370
- In vitro and in vivo biocompatibility of a polyalkylimide hydrogel for soft tissue augmentation.J Biomed Mater Res. 2005; 72: 230-238
- Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery.Plastic Reconstruct Surg. 1989; 83: 368-381
- Objective evidence for the use of polylactic acid implants in HIV-associated facial lipoatrophy using three dimensional surface laser scanning and psychological assessment.J Plast Reconstruct Aesthetic Surg. 2009; 62: 1627-1635
- Reconstructive treatment for antiretroviral-associated facial lipoatrophy: a prospective study comparing autologous fat and synthetic substances.AIDS Patient Care Stds. 2006; 20: 829-837
- Comparison of three different interventions for the correction of HIV-associated facial lipoatrophy: a prospective study.Antiviral Ther. 2005; 10: 753-759
- Does severity predict distress? The relationship between subjective and objective measures of appearance and psychological adjustment, during treatment for facial lipoatrophy.Body Image. 2007; 4: 239-248
- Initial post-traumatic stress responses following motor-vehicle accidents.J Trauma Stress. 1996; 9: 223-234
- Late-appearing abscesses after injections of nonabsorbable hydrogel polymer for HIV-associated facial lipoatrophy.Dermatol Surg. 2007; 33: 193-198
- Complications of polyalkylimide 4% injections (Bio-alcamid): a report of 18 cases.J Plast Recontruct Aesthetic Surg. 2006; 59: 1409-1414
- Early and late complications of polyalkylimide gel (Bio-Alcamid).J Plast Reconstuct Aesthetic Surg. 2011; 64: 401-404
- Use of hyaluronic acid for soft tissue augmentation of HIV associated facial lipodystrophy.Dermatol Surg. 2005; 31: 104-108
- Local treatment of facial lipodystrophy in patients receiving HIV protease inhibitor therapy.Acta Chirurgiae Plasticae. 2001; 43: 54-56
- Restorative treatment of HIV-associated facial lipoatrophy.Plast Reconstruct Surg. 2005; 116: 29-30
- Differential gene expression indicates that ‘buffalo hump’ is a distinct adipose tissue disturbance in HIV-1-associated lipodystrophy.AIDS. 2008; 22: 575-584
Published online: December 07, 2011
Accepted: November 8, 2011
Received: August 18, 2011
☆Presentations: EURAPS Annual Meeting, Manchester, May 2010, Royal Society of Medicine Facial Reconstruction Meeting, Edinburgh, March 2011.
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.