HIV-associated facial lipoatrophy is a stigmatizing condition associated with
significant psychological morbidity. The condition may be treated with soft tissue
fillers, although quantification of objective and patient- reported outcomes is lacking.
The primary aim of this study was to evaluate change in facial volume and
psychological morbidity following treatment for HIV lipodystrophy with autologous fat
transfer, Newfill and Bio-alcamid. An additional aim of the study was to compare
psychological characteristics between HIV seropositive patients with lipodystrophy
(HIV LD) and without lipodystrophy (HIV non -LD) and HIV seronegative men who
have sex with men (MSM).
HIV LD patients were treated with autologous fat, Newfill or Bio- alcamid based on a
clinical assessment in a prospective, observational study. The Colemnan technique of
fat transfer was utilised. Newfill injections were carried out at monthly intervals using
1 vial per cheek. Bio- alcamid was injected subcutaneously under aseptic technique to
achieve the desired cheek augmentation. 3 -D images were obtained pre- operatively
then at 2, 6 and 12 months post -operatively using the DI3D system. Volume changes in
treated areas were measured using DI3D software. The DAS -24 and HADS were used
to assess psychological morbidity at similar time intervals.
An additional case -control study was conducted to measure psychological morbidity in
HIV LD, HIV non -LD and MSM groups utilising the Derriford Appearance Scale
(DAS -24) and Hospital Anxiety and Depression Scale (HADS).
Data was analyzed using appropriate statistical tests.
ANOVA tests demonstrated significantly higher DAS -24 scores in the HIV -LD group
compared to the HIV non -LD and MSM groups. No difference in HADS -A scores was
seen between groups.
48 patients with HIV LD were treated: 16 patients had Bio- alcamid augmentation, 20
patients received Newfill injections and 12 patients underwent fat transfer. The mean
injected volume of Bio- alcamid was 25.5cc The Wilcoxin test demonstrated no
significant difference in mean volume change relative to zero at 2, 6 and 12 months.
The mean injected volume of fat was 20.1cc, which did not differ from the measured
volumes at 2 months (1)= 0.15). There was a mean reduction in measured volume of
7.3cc at 6 months and 9cc at 12 months (p <0.001).
For Newfill, the mean volume change compared to baseline was 8.7cc at 2months,
increasing to 12.6cc at 6 months and 12.3cc at 12 months.
ANOVA tests demonstrated no difference in psychological outcomes between groups.
There was a significant improvement in DAS -24 scores compared too baseline for all 3
groups throughout follow -up. For Bio- alcamid, a significant improvement in HADS -A
and HADS -D scores were seen at 2 months but mean scores increased at 6 and 12
months. In the fat group, some improvement in HADS -A and HADS -D scores were
seen at follow -up, although values only reached significance at 6 months. In the
Newfill group, small improvements in both HADS -A and HADS -D were demonstrated
in the post -treatment scores, although these did not reach significance. No correlation
between change in facial volume and psychological measures was demonstrated.
The case control study demonstrated that patients with HIV lipodystrophy have greater
distress relating to body image and depression compared to HIV-seropositive patients
without lipodstrophy and HIV-seronegative MSM control groups.
The prospective study of the HIV LD treatment cohort demonstrated a change in 3 -D
measured facial volume for all 3 groups. Bio-alcamid produced the greatest, permanent
volume change but was associated with the most complications. Newfill was associated
with a moderate, delayed volume augmentation but was insufficient for some patients
with severe lipoatrophy. Volume enhancement with autologous fat was good
immediately post-operatively but variable degrees of fat resorption occurred. Treatment
was associated with improved body image perception. However, initial improvements
in anxiety and depression symptoms were not maintained in the long term.