Quality-of-Life Improvement With the Use of Semipermanent Fillers for HIV Lipoatrophy

In the January 2014 issue of Aesthetic Surgery Journal (2014;34:118-132), van Rozelaar et al studied the quality-of-life (QOL) effects and magnetic resonance imaging (MRI) changes seen in patients who are human immunodeficiency virus (HIV) positive and are treated with semipermanent fillers, poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA). They followed an 82-patient cohort for 1 year; all patients had facial lipoatrophy (FLA) of grades 2 to 4. Forty-one patients had PLLA injected (mean volume, 58.2 mL; range, 12–105 mL) and 41 patients had CaHA injected (mean volume, 9.1 mL; range, 3–23 mL) done in multiple sessions. The MRI examinations were performed prior to treatment and again 12 months after. The severity of FLA as well as QOL was measured using self-reported questionnaires based on the 36-Item Short Form Health Survey, Medical Outcomes Study HIV Health Survey, and Center for Epidemiologic Studies Depression Scale formats.

Of the patients enrolled, 49 patients completed the 1-year follow-up posttreatment MRI: 26 treated with PLLA and 23 treated with CaHA. Eleven CaHA patients (47.8%) were treated in the buccal region only, while 6 patients (23.1%) in the PLLA group were injected in the buccal region only. No significant change in total subcutaneous thickness (TST) was observed at the level of the mandibular head. Injection of PLLA and CaHA showed an increase in TST buccally (P=.69) and temporally (P=.26). Temporal TST increase was more pronounced in PLLA patients compared with CaHA-treated patients. Of note, collagen formation also was observed in 25 PLLA patients (96.2%) and 19 CaHA patients (82.6%) and was defined as well-demarcated hypointense subcutaneous tissue on MRI. Adipose tissue also was shown to increase significantly in both groups (19 PLLA patients [73.1%] and 15 CaHA patients [65.2%]). The MRI examinations revealed only 1 nodule in a PLLA patient.

Quality of life improved significantly on all subscales tested (P<.01), including role functioning (physical and emotional), social functioning, and mental health. Depressive symptoms also were reported to decrease significantly over time (P<.001). Interestingly, the percentage of patients receiving sickness benefits because of lipoatrophy decreased significantly over time (P<.001). Patients treated with CaHA had more favorable scores than patients treated with PLLA regarding self-rated severity of lipoatrophy.

What’s the issue?

It is well known that FLA is a cutaneous side effect of both HIV itself and medication usage, which has notable QOL effects. This prospective study showed that the use of semipermanent fillers had a remarkable impact on self-reported QOL parameters. The authors also reported that it was the first study using MRI as a measurement tool. Although this cohort study did have a notable number of patients who did not complete the MRI evaluation, it did show that there were lasting results 1 year after treatment. The treatment of FLA with PLLA and CaHA injections increased TST in both buccal and temporal regions, which was associated with QOL improvement in all subscales after start of treatment. The CaHA cohort obtained higher scores in the QOL assessment, which was postulated to be the result of CaHA’s immediate results. With the wide use of fillers, it is important to understand the QOL effects for all populations. Do you think all populations have similar increases in QOL?

We want to know your views. Tell us what you think.