Use of Polylactic Acid Implants to Correct Facial Lipoatrophy in Human Immunodeficiency Virus 1–Positive Individuals Receiving Combination Antiretroviral Therapy

Cattelan, Anna María; Bauer, Ute; Trevenzoli, Marco; Sasset, Lolita; Campostrini, Stefano; Facchin, Chiara; Pagiaro, Emilio; Gerzeli, Stefano; Cadrobbi, P; Chiarelli, Angelo

doi:10.1001/archderm.142.3.329

Cited by 42 publications

(50 citation statements)

References 23 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These changes, while lower than the week 48 changes reported in some studies [9,11,17], are comparable to those reported in others [13,14]. However, cross-study comparisons of PLA efficacy for HIV facial lipoatrophy are problematic because of the heterogeneity of these studies.…”

Section: Discussionsupporting

confidence: 60%

“…Validated measures of facial soft tissue thickness or volume for assessing and/or comparing treatment efficacy are also lacking. Measurement methods employed have included ultrasonography [9,14,17], callipers [11], and 3D photography with 3D computerized reconstruction of the face [13], none of which has been validated. Collectively, these factors demonstrate the lack of scientifically valid data that relate Table 2 Overall procedure/product-related adverse events to week 48 to this treatment approach, and assist in explaining the broad inter-study variability in PLA treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Although open-label studies have demonstrated PLA safety in HIV-infected adults [9][10][11][12][13][14][15][16][17][18], PLA efficacy has been objectively assessed in only one randomized clinical trial [19]. This open-label, multicentre study compared immediate vs. deferred PLA injections in adults with moderate to severe facial lipoatrophy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Poly‐l‐lactic acid for HIV‐1 facial lipoatrophy: 48‐week follow‐up

Carey¹,

Baker²,

Petoumenos³

et al. 2009

HIV Medicine

View full text Add to dashboard Cite

ObjectivesPoly-L-lactic acid (PLA) injections modestly increase objectively assessed facial thickness but not facial soft tissue volume (FSTV) over 24 weeks. The durability of this response has not been well defined objectively. MethodsHIV-infected lipoatrophic adults were randomized to four open-label PLA treatments administered every 2 weeks from week 0 (immediate group, n 5 50) or from week 24 (deferred group, n 5 50). Endpoints included FSTV assessed by computed tomography, facial lipoatrophy severity, quality of life (QoL) and safety. Analyses were by intention to treat. ResultsBetween weeks 24 and 48, soft tissue thickness increased modestly in injection planes, at the maxillary [mean 0.9 mm; 95% confidence interval (CI) 0.3-1.5 mm; P 5 0.007] and base of nasal septum levels (mean 0.4 mm; 95% CI 0.1-0.8; P 5 0.021), but not in untreated areas (P 5 0.79 and P 5 0.24). PLA durability assessed at week 48 in immediate group participants showed a mean change in FSTV of 14 cm 3 (95% CI À1 to 29 cm 3 ; P 5 0.060) and increased tissue depth at the maxillary (Po0.0001), base of nasal septum (Po0.0001) and mandibular (P 5 0.0035) levels. At week 48, clinicians and patients subjectively assessed facial lipoatrophy severity as reduced in immediate participants (83 and 91%, respectively), and the Mental Health scale score of the Short Form-36 Health Survey improved significantly in immediate participants relative to deferred participants (P 5 0.027). Subcutaneous injection-site nodule incidence at 48 weeks was 10%. ConclusionsPLA treatment benefits were durable, with objectively assessed modest increases in facial volume and tissue thickness sustained over 48 weeks in injection planes but not in other facial areas. Improvements in some QoL domains were maintained. IntroductionLipoatrophy of subcutaneous adipose tissue in the limbs, face and buttocks, and accumulation of adipose tissue in the intra-abdominal space, dorsocervical region and the breasts are major features of HIV lipodystrophy [1,2].Facial lipoatrophy, the most distressing manifestation, can be stigmatizing, severely affecting quality of life (QoL) and self-esteem, and may result in reduced antiretroviral (ARV) adherence [3]. Although use of the newer nonthymidine nucleoside reverse transcriptase inhibitors is associated with less lipoatrophy [4], in the absence of proven therapies, management of established fat loss can be challenging as reversal is slow [5][6][7].An array of injectable filling agents has been marketed for soft tissue augmentation and many of these are used for aesthetic management of HIV facial lipoatrophy [8]. Methods ParticipantsDetails of participants' eligibility, randomization and baseline characteristics have been reported previously in the 24-week primary efficacy comparison [19]. All participants provided written, informed consent following approval by the local human research ethics committee at each site. InterventionsAt baseline, 100 eligible patients were randomized to receive four open-label PLA treatments [one vial (150 m...

show abstract

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Poly‐l‐lactic acid for HIV‐1 facial lipoatrophy: 48‐week follow‐up

Carey¹,

Baker²,

Petoumenos³

et al. 2009

HIV Medicine

View full text Add to dashboard Cite

show abstract

“…[9][10][11][12][13][14][15][16][17][18][19] A description of the semipermanent and permanent dermal filler products within these studies is provided in Table 3. Autologous fat transfer (AFT) was used as a comparator in three studies.…”

Section: Resultsmentioning

confidence: 99%

“…[20][21][22] There were substantial differences in study design within the included studies which prevented statistical pooling. One study 9 compared patients who had been treated to those who had not, other studies compared different treatments in separate patient groups, 10,11 and others compared changes from baseline for a single intervention 13,14,[16][17][18][19] or several interventions. 12 One study reported outcomes for patients who had complete correction of lipoatrophy after treatment.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Permanent and Semipermanent Dermal Fillers for HIV-Associated Facial Lipoatrophy

Sturm

Cooter

Mutimer³

et al. 2009

AIDS Patient Care and STDs

View full text Add to dashboard Cite

The objective of this study was to assess the safety and efficacy of injectable semipermanent and permanent dermal fillers, compared to other facial augmentation techniques, for the management of facial lipoatrophy as a result of highly active antiretroviral therapy (HAART) for HIV infection through a systematic review of the literature. A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was by the application of a predetermined protocol, independent assessment by two reviewers, and a final consensus decision. One randomized controlled trial (RCT), one pseudo-RCT, two nonrandomized comparative studies, and seven case series were included for review. Injections with permanent and semipermanent dermal fillers improved subjective ratings of appearance and resulted in high patient satisfaction. Although short-term safety appeared favorable, of the seven studies that reported lumps, three studies reported these events in more than 40% of patients. Long-term safety data were lacking. Evidence suggests that permanent and semipermanent dermal fillers achieve their objective, which is to decrease the visible effects of HIV-associated facial lipoatrophy, with high patient satisfaction. Safety appears favorable in the short term, but further studies are required to determine long-term outcomes.

show abstract

Women's Dermatologic Diseases, Health Care Delivery, and Socioeconomic Barriers

Robinson¹,

Ramos-e-Siliva²

2006

Arch Dermatol

View full text Add to dashboard Cite

Use of Polylactic Acid Implants to Correct Facial Lipoatrophy in Human Immunodeficiency Virus 1–Positive Individuals Receiving Combination Antiretroviral Therapy

Cited by 42 publications

References 23 publications

Poly‐l‐lactic acid for HIV‐1 facial lipoatrophy: 48‐week follow‐up

Poly‐l‐lactic acid for HIV‐1 facial lipoatrophy: 48‐week follow‐up

A Systematic Review of Permanent and Semipermanent Dermal Fillers for HIV-Associated Facial Lipoatrophy

Women's Dermatologic Diseases, Health Care Delivery, and Socioeconomic Barriers

Contact Info

Product

Resources

About