Using a facial filler such as polyalkylimide gel (PAIG) injections can correct the antiretroviral-associated facial lipoatrophy that can be quite severe in HIV-infected individuals, Canadian investigators report in May 31st issue of AIDS.
They say PAIG injections are effective, improve quality of life, and lessen anxiety and depression.
PAIG has an advantage over other facial fillers in that it is a polymer that becomes encapsulated with collagen, Dr. Mona R. Loutfy and colleagues at the University of Toronto, Ontario, Canada, note. While PAIG fillers are permanent, the manner in which they become encapsulated allows for their removal, if necessary.
The investigators randomized 31 HIV-positive individuals, mean age of 48 years, to receive either immediate PAIG injections, administered at weeks 0 and 6, or delayed injections, at weeks 12 and 18.
The team injected a median volume of 16.0 ml bilaterally per patient to the subcutaneous plane.
All adverse events, including redness, pain and swelling and bruising, resolved after a median of three days. There were no cases of necrosis, infection or the development of nodules.
Compared to patients randomized to delayed treatment, those assigned to immediate injections had significantly less lipoatrophy, better quality of life and less anxiety and depression at 12 week.
At 12 weeks, physicians assigned a median lipoatrophy score of 0 on a 5-point scale for the early injected group compared with a score of 2 for those who received later injections. At 48 weeks, scores were 0 and 1 for the early and late groups, respectively, indicating no significant differences in lipoatrophy between the two groups.
There were significant improvements in depression and anxiety scores seen by week 12 in the early injection group, with the effects maintained through 48 weeks.
Dr. Loutfy and colleagues acknowledge that cost is a significant limitation of PAIG, with each milliliter priced at approximately $175 in Canada at the time of the study. Patients typically require 10-25 ml per treatment, at a cost of $1,750 to $4,375.
AIDS 2007;21:1147-1155.
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