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

Affiliations
  • 1Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
  • 2Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 3Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

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.

  • 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.

  • 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.


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