Changes to Your Face (Facial Lipoatrophy) en español
How can facial lipoatrophy be treated?
Because we do not yet fully understand how or why lipoatrophy occurs in HIV-positive people, the development of treatments has been challenging. Fortunately, the effective management of facial lipoatrophy has been a priority for several researchers and for companies with promising products. Here is a quick look at some of the treatment options being explored in research:
Switching therapies: For HIV-positive people who have developed lipoatrophy while taking a drug regimen that contains a suspect medication—Zerit or Retrovir, for example—one option might be to change these drugs for another drug that is less likely to cause lipoatrophy (for example, Viread or Ziagen). This, many experts point out, is the easiest of all the possible treatment approaches. In a handful of clinical trials, this approach has been shown to prevent further lipoatrophy, and sometimes reverse the problem, in patients who develop lipoatrophy while taking Zerit or Retrovir. This approach appears to work best if the medications are switched before lipoatrophy becomes severe.
Adjunctive therapies: We don't yet have any medications that have been proven to be safe and effective for the management of facial lipoatrophy. However, researchers are exploring possible options in clinical trials. Thiazolidinediones—sometimes referred to as "glitazones"—represent one class of drugs being studied. These medications, which include rosiglitazone (Avandia) and pioglitazone (Actos), are best known for the ability to makes cells more sensitive to insulin (hence their use for the treatment of diabetes). They have also been shown to help correct the function of fat cells. As a result, they have been studied as potential treatments for lipodystrophy.
In 2004, the results of a large Australian study were published. It evaluated Avandia (4mg twice-daily) or placebo in patients who had lipoatrophy. The study failed to find any benefit; there were no statistically significant gains in subcutaneous fat among patients taking the drug compared to those who received the placebo. However, some data from more recent studies suggest that the glitazones may be somewhat helpful in reversing lipoatrophy. There are still some concerns about using this class of drugs in non-diabetic patients and additional studies will need to be conducted to further evaluate their safety and effectiveness in non-diabetic HIV-positive people with lipoatrophy.
There has also been a lot of interest in complementary therapies that can be purchased over-the-counter (without a prescription). For example, uridine is a molecule that, in test tube studies, has been shown to prevent and reverse damage to cellular mitochondria. One commercially available product—NucleomaxX, which can be purchased online from other countries —contains high concentrations of uridine. A study reported in November 2005 evaluated the effect of NucleomaxX on subcutaneous leg fat in patients experiencing lipoatrophy and after three months of treatment, patients receiving NucleomaxX saw their leg fat increase by 1 kilogram (2.2 pounds), compared to a .2 kilogram (0.44 pounds) increase in the placebo group.
Facial fillers: There has been a lot of interest in restorative therapies—such as facial filler injections and implants—for facial lipoatrophy. Two facial fillers, poly-L-lactic acid (Sculptra) and calcium hydroxylapatite (Radiesse), have been approved by the U.S. Food and Drug Administration (FDA) specifically for HIV-positive people with lipoatrophy, and several other facial fillers are being studied and used experimentally all over the world. There are important similarities and differences between the various facial fillers being studied, which are the focus of the remainder of this lesson.
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