J Korean Med Sci.  2022 Feb;37(5):e37. 10.3346/jkms.2022.37.e37.

Treatment of Human Immunodeficiency Virus-Associated Facial Lipoatrophy With Hyaluronic Acid Filler Mixed With Micronized Cross-Linked Acellular Dermal Matrix

• Kim J
• Song SY
• Lee SG
• Choi S
• Lee YI
• Choi JY
• Lee JH

• KMID: 2525489
• DOI: http://doi.org/10.3346/jkms.2022.37.e37

Abstract

Background
Human immunodeficiency virus (HIV)-associated facial lipoatrophy (FLA) is a stigmatizing side effect associated with the use of highly active antiretroviral therapy. We sought to evaluate the safety and efficacy of the hyaluronic acid filler mixed with micronized cross-linked acellular dermal matrix (HA/MADM) in HIV-associated FLA.
Methods
We conducted an open-label safety and efficacy study in patients with HIVassociated FLA. Fourteen patients received single injection of the HA/MADM, and 13 patients completed the 24-week follow-up evaluation. Treatment efficacy, safety, and patient and physician satisfaction were evaluated. Repeated measure analysis of variance with post-hoc analysis with the Wilcoxon signed rank test was performed to compare and incorporate parameters at each time point.
Results
All 13 patients maintained a significant improvement of the Carruthers Lipoatrophy Severity Scale grade throughout the study period, along with improvement of the depressed volume due to lipoatrophy measured using a three-dimensional camera system. More than 80% of patients and physicians were satisfied with the treatment, and no treatment-related adverse events were reported, except for one case of transient subcutaneous nodule formation.
Conclusion
Our study findings suggest that injectable HA/MADM is a potentially effective and safe treatment option for treating HIV-positive patients with FLA.

Keyword

HIV; Lipoatrophy; Dermal Fillers

Figure

• 

  Fig. 1 Average (A) CLSS grade, (B) depressed volume measured using the Antera 3D® camera system, and (C) skin elasticity measured using the Cutometer® over the study period. Error bars depict the standard error of the mean.CLSS = Carruthers Lipoatrophy Severity Scale, R2 = percentage of viscoelasticity.**P < 0.01 in post-hoc analysis at each time point.

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  Fig. 2 Clinical photographs of patient number 3 (A) before the injection (baseline), (B) 1 month after the injection, and (C) at the 6-month follow-up visit. Images of the depression mode of the Antera 3D® camera system correspond well with the clinical photographs; (D) before the injection (baseline), (E) 1 month after the injection, and (F) at the 6-month follow-up visit. The depressed volume within the area surrounded by the red dotted line is quantitatively measured. The red arrow indicates the site of filler injection. The figures are published under agreement of the patient.

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  Fig. 3 Clinical photographs of patient number 5 (A) before the injection (baseline), (B) 1 month after the injection, and (C) at the 6-month follow-up visit. Images of the depression mode of the Antera 3D® camera system corresponds well with the clinical photographs; (D) before injection (baseline), (E) after 1-month, and (F) 6-month follow-up visit. The depressed volume within the area surrounded by the red dotted line is quantitatively measured. The red arrow indicates the site of filler injection. The figures are published under agreement of the patient.

• 

  Fig. 4 Subjective patient and physician satisfaction with treatment outcome assessed by the Global Aesthetic Improvement Scale.

Reference

1. Carr A, Miller J, Law M, Cooper DA. A syndrome of lipoatrophy, lactic acidaemia and liver dysfunction associated with HIV nucleoside analogue therapy: contribution to protease inhibitor-related lipodystrophy syndrome. AIDS. 2000; 14(3):F25–F32. PMID: 10716495.

2. Corless IB, Kirksey KM, Kemppainen J, Nicholas PK, McGibbon C, Davis SM, et al. Lipodystrophy-associated symptoms and medication adherence in HIV/AIDS. AIDS Patient Care STDS. 2005; 19(9):577–586. PMID: 16164384.

3. Rajagopalan R, Laitinen D, Dietz B. Impact of lipoatrophy on quality of life in HIV patients receiving anti-retroviral therapy. AIDS Care. 2008; 20(10):1197–1201. PMID: 18608076.

4. Jagdeo J, Ho D, Lo A, Carruthers A. A systematic review of filler agents for aesthetic treatment of HIV facial lipoatrophy (FLA). J Am Acad Dermatol. 2015; 73(6):1040–1054.e14. PMID: 26481056.

5. Koethe JR, Lagathu C, Lake JE, Domingo P, Calmy A, Falutz J, et al. HIV and antiretroviral therapy-related fat alterations. Nat Rev Dis Primers. 2020; 6(1):48. PMID: 32555389.

6. Ho D, Jagdeo J. Safety and efficacy of a volumizing hyaluronic acid filler for treatment of HIV-associated facial lipoatrophy. JAMA Dermatol. 2017; 153(1):61–65. PMID: 27806168.

7. Jones D, Murphy DK. Volumizing hyaluronic acid filler for midface volume deficit: 2-year results from a pivotal single-blind randomized controlled study. Dermatol Surg. 2013; 39(11):1602–1612. PMID: 24093664.

8. Shuck J, Iorio ML, Hung R, Davison SP. Autologous fat grafting and injectable dermal fillers for human immunodeficiency virus-associated facial lipodystrophy: a comparison of safety, efficacy, and long-term treatment outcomes. Plast Reconstr Surg. 2013; 131(3):499–506. PMID: 23142937.

9. Moyle GJ, Brown S, Lysakova L, Barton SE. Long-term safety and efficacy of poly-L-lactic acid in the treatment of HIV-related facial lipoatrophy. HIV Med. 2006; 7(3):181–185. PMID: 16494632.

10. Carruthers A, Carruthers J. Evaluation of injectable calcium hydroxylapatite for the treatment of facial lipoatrophy associated with human immunodeficiency virus. Dermatol Surg. 2008; 34(11):1486–1499. PMID: 18811715.

11. Skeie L, Bugge H, Negaard A, Bergersen BM. Large particle hyaluronic acid for the treatment of facial lipoatrophy in HIV-positive patients: 3-year follow-up study. HIV Med. 2010; 11(3):170–177. PMID: 19780861.

12. Beasley KL, Weiss MA, Weiss RA. Hyaluronic acid fillers: a comprehensive review. Facial Plast Surg. 2009; 25(2):86–94. PMID: 19415575.

13. Lee JH, Kim HG, Lee WJ. Characterization and tissue incorporation of cross-linked human acellular dermal matrix. Biomaterials. 2015; 44:195–205. PMID: 25617138.

14. Park TH, Choi WY, Lee JH, Lee WJ. Micronized cross-linked human acellular dermal matrices: an effective scaffold for collagen synthesis and promising material for tissue augmentation. Tissue Eng Regen Med. 2017; 14(5):517–523. PMID: 30603506.

15. Yang CE, Kim SJ, Kim JH, Lee JH, Roh TS, Lee WJ. Usefulness of cross-linked human acellular dermal matrix as an implant for dorsal augmentation in rhinoplasty. Aesthetic Plast Surg. 2018; 42(1):288–294. PMID: 29124378.

16. Kim JH, Kim SE, Kim YJ, Kim YW, Cheon YW. Comparison of volume retention and biocompatibility of acellular dermal matrix/hyaluronic acid filler to autologous fat grafts in a mouse model. Aesthetic Plast Surg. 2020; 44(3):986–992. PMID: 32232518.