HIV-Associated Facial Lipoatrophy

James, J; Carruthers, Alastair; Carruthers, Jean

doi:10.1046/j.1524-4725.2002.02099.x

Cited by 90 publications

(81 citation statements)

References 62 publications

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“…However, if these reference points are also displaced in the same direction as the central circle of measurement, the process of superimposition of scans will in effect minimize the estimated central surface volume difference. Although changes occurring in HIV lipoatrophy are most obvious in the centre of the cheek, in advanced cases they can extend as far as the temples and orbit [14,26]. This source of error was not present in our mannequin model because the plasticine was only applied in the centre of the cheek, and the reference points on the surrounding areas were not affected [22].…”

Section: Discussionmentioning

confidence: 99%

Validation of three‐dimensional laser scanning for the assessment of facial fat changes

Paton

Yang

et al. 2007

HIV Medicine

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ObjectiveWe aimed to evaluate the accuracy of three-dimensional laser scanning as an objective method for detecting facial changes. MethodsFacial laser scanning was performed at baseline and repeated after a median of 10 months in 24 HIVinfected patients, 12 with ongoing lipodystrophy, five with 410% weight loss and seven with 410% weight gain. Surface volume change was estimated using a standardized technique, and compared with change in cheek fat measured by magnetic resonance imaging (MRI). ResultsThe median laser scanning surface volume changes were À 2.1 (range À 4.6 to À 0.8) mL in the lipoatrophy group, À1.5 (range À6.8 to À1.3) mL in the weight loss group and 13.1 (range À 0.2 to 1 5.4) mL in the weight gain group (the median MRI cheek fat changes were À 4.6, À 3.7 and 1 7.0 mL in the three groups, respectively). Laser scanning and MRI measurements were not significantly associated in lipoatrophy patients (r 5 0.34, P 5 0.28), but there was a good association in patients who changed weight (r 5 0.71, P 5 0.01). ConclusionsLaser scanning detects changes in the appropriate direction, although it underestimates MRImeasured cheek fat changes. Laser scanning may be useful as an objective measure of cheek surface volume changes, but needs further validation in larger clinical cohorts.Keywords: accuracy, fat, HIV, laser scanning, lipoatrophy, magnetic resonance imaging, reproducibility IntroductionChanges in facial appearance are one of the most distressing aspects of the lipodystrophy syndrome for patients with HIV disease. The resulting stigma and psychological morbidity may adversely affect quality of life and result in compromised adherence to antiretroviral therapy (ART) [1][2][3][4]. Consideration of lipoatrophy risk influences the selection of drugs for new antiretroviral regimens [5].A number of research studies have evaluated potential interventions for facial lipoatrophy, including switching to regimens without thymidine analogues [6][7][8] and injection of facial fillers such as polylactic acid [9][10][11] and silicone [12]. However, there is currently no accepted objective method for measuring the onset and progress of lipodystrophy or for assessing the reversibility of the changes that occur as a result of therapeutic interventions. Evaluation of lipodystrophy in clinical trials is currently based on patient self-assessment and/or physician assessments, although these are subjective and have been shown to be insensitive for detecting changes over time [13]. Although dual-energy X-ray absorptiometry is often used to measure changes in peripheral lipoatrophy in clinical research, this method is not suitable for detecting facial fat changes. Facial magnetic resonance imaging (MRI) and computerized tomography (CT) have been used successfully in measuring facial soft tissue volumes, but these techniques Three-dimensional laser scanning has been used in research and clinical practice to generate images of facial contour that may be used for planning maxillofacial surgery, measuring craniofacial deformit...

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Section: Discussionmentioning

confidence: 99%

Validation of three‐dimensional laser scanning for the assessment of facial fat changes

Paton

Yang

et al. 2007

HIV Medicine

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“…Therefore, patients with facial changes are more worried about stigmatization. Facial lipoatrophy was cited as an important stigmatizing factor for HIV patients, rendering them more vulnerable to the identification of seropositivity and consequently leading to decreased self-esteem and socialization (9)(10) .…”

Section: Methodsmentioning

confidence: 99%

“…The "contamination" of body image currently associated with lipodystrophy has been documented; however, the mechanisms underlying the visible disfiguring and stigmatizing morphological changes are still unknown (10,15,17) . In addition, BLANCH and colleagues (9) found that decreased sexual enjoyment and activity were observed after the development of lipodystrophy; however, there were no change in the frequency of condom use.…”

Section: Methodsmentioning

confidence: 99%

Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects

Fernandes

Sanches

Mill

et al. 2007

Rev. Latino-Am. Enfermagem

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“…The catalytic site of HIV-protease, to which PIs bind shares approximately 63% of 12-amino acid sequence homology with a region incorporating a lipid binding domain in the low-density lipoprotein receptor-related protein (LRP) and 58% with a C-terminal region of the cytoplasmic retinoic acid binding protein type 1 (CRABP-1) [15,17], respectively. Under normal circumstances, CRABP-1 binds to intracellular retinoic acid (RA) and accelerates its conversion to 9-cis-RA, a major ligand of the retinoic X receptor (RXR) [15,17,25,26]. Then, the heterodimerization of RXR with peroxisome proliferator-activated receptor-gamma (PPAR-γ) significantly enhances the binding affinity of 9-cis-RA to RXR [15,17,25].…”

Section: Pis and Lipid Metabolismmentioning

confidence: 99%

“…This is sabotaged by PIs which increase apoptosis and reduce differentiation of peripheral adipocytes [15,17,25]. PIs have further been reported to inhibit cytochrome P450 3A, which is required for the conversion of RA to cis-9-RA hence contributing to the impairment of peripheral adipocytes functions [17,26,27] and also reduces the expression of PPAR-γ, leading to less differentiation of pre-adipocytes [25].…”

Section: Pis and Lipid Metabolismmentioning

confidence: 99%

Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome and Lipodystrophy: Pathophysiology and Current Therapeutic Interventions

et al. 2017

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The use of highly active antiretroviral therapy (HAART) has extremely enhanced the clinical outcome of HIV disease with a decrease in mortality and morbidity. However, the inclusion of protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (tNRTIs) has strongly been linked to the development of metabolic abnormalities and lipodystrophy. Lipodystrophy is defined by the loss of peripheral subcutaneous fat and central adiposity, mainly in the abdomen, breast and dorsocervical region. These disorders are reported to be cosmetically distressing and socially stigmatizing to many patients leading to decreased adherence to antiretroviral therapy. Metabolic syndrome precedes lipodystrophy leading to increased risk of diabetes and cardiovascular diseases. With a shifted trajectory of HIV/AIDS morbidity from immunodeficiency and opportunistic infections to metabolic complications, clinical management of these patients has therefore become more complex. Currently there are no evidence-based standard guidelines for the management of HIV-associated lipodystrophy. Several pharmacological interventions such as using anti-diabetic, anti-dyslipidemic drugs or hormone replacement therapy have been tried to effectively improve metabolic syndrome and lipodystrophy but have been hampered by low efficacy, drug interactions, or unwanted side-effects. Non-pharmacological interventions including surgical manipulations, dietary and lifestyle modifications have also been tried with limited success. This review focuses on the proposed mechanisms involved in the development of metabolic syndrome and lipodystrophy, and highlights suggested potential therapeutic interventions to prevent lipodystrophy associated with HAART.

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HIV-Associated Facial Lipoatrophy

Abstract: Lipodystrophy and lipoatrophy are intimately related to infection with HIV. In consequence, facial lipoatrophy is a major stigma for HIV-infected individuals and can have dramatic effects on their self-esteem and socialization. Effective treatment is essential.

Cited by 90 publications

References 62 publications

Validation of three‐dimensional laser scanning for the assessment of facial fat changes

Validation of three‐dimensional laser scanning for the assessment of facial fat changes

Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects

Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome and Lipodystrophy: Pathophysiology and Current Therapeutic Interventions

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