Restorative Interventions for HIV Facial Lipoatrophy

Facial lipoatrophy is a common and distressing manifestation of HIV lipodystrophy. The changes infacial appearance can reduce quality of life, self esteem and antiretroviral adherence. Apart from themodest benefits of thymidine-based nucleoside analog cessation, there are no proven therapies forlipoatrophy. Management of established fat loss can be challenging as restoration of lost fat mass isextremely gradual. Plastic surgery and cosmetic procedures can restore lost facial volume. Bothbiodegradable and permanent filling agents have been investigated for HIV facial lipoatrophy. Biodegradableproducts offer a good safety profile, but maintenance of aesthetic benefits necessitates reinjectionover time. Although permanent products offer longevity and lower treatment costs, adverseevents should they occur can be serious and of long duration. Despite the substantial increase inoptions for soft-tissue augmentation in recent years, well-performed clinical studies in HIV-infectedadults with facial lipoatrophy are scarce, and long-term clinical safety data are lacking. This reviewwill summarize available efficacy and safety data of the biodegradable and permanent agents utilizedfor soft-tissue augmentation in this population. Difficulties associated with comparing treatment efficacydata, assessment of facial lipoatrophy presence and severity, and measurement of facial fat willbe discussed. Available data indicate that in HIV-infected adults, most filling agents have short-termclinically safety, and can provide aesthetic improvement and improve well-being, social functioningand quality of life. However, well-designed studies with objectively assessed endpoints are needed toelucidate optimal treatments for this distressing condition.