HIV-related lipodystrophy and facial lipoatrophy: The role of Restylane SubQ in reversing facial wasting

Abstract

HIV-associated lipodystrophy syndrome affects approximately 50% of HIV-positive patients, particularly those receiving antiretroviral therapy based on nucleoside reverse transcriptase inhibitors and protease inhibitors. Growing evidence suggests that certain antiretroviral drugs may precipitate or exacerbate lipoatrophy and associated metabolic abnormalities, and this is an important consideration when selecting appropriate treatment regimens. However, because of problems of cross-resistance among antiretroviral drug classes and other treatment-related toxicities, it is likely that, at some stage, the HIV-infected patient will have to take drugs that confer a risk of development of lipodystrophy syndrome. Combination therapy for HIV, known as highly active antiretroviral therapy (HAART), has dramatically altered the prognosis for the HIV-infected individual. With optimal use of HAART, which includes regular monitoring of viral load, viral resistance, and compliance with medication, HIV infection has changed from being a fatal disease to a lifelong infection. However, HAART-related lipodystrophy syndrome, and especially facial lipoatrophy, is of great concern for patients and physicians involved in HIV care. For the patient, facial lipoatrophy is a major stigma that affects self-esteem and social interaction, and in some cases, it is a cause of noncompliance with HAART. Accordingly, many treatment-experienced HIV patients are requesting, and being treated with, various dermal fillers for cosmetic correction of facial lipoatrophy. Prior to the introduction of HAART, when life expectancy for the HIV-infected individual was severely limited, permanent fillers were widely used for this purpose. Because these products remain in situ indefinitely and the facial soft tissues change over time, the permanent fillers are no longer a satisfactory treatment option. Now that HIV infection has been transformed into a chronic but not necessarily life-threatening disease, there is an urgent need for a safe, biodegradable, and biocompatible alternative dermal filler for treating HIV-associated facial lipoatrophy.