Long-Term Effect of Polyalkylimide Gel Injections on Severity of Facial Lipoatrophy and Quality of Life of HIV-Positive Patients

Abstract

Highly active antiretroviral therapy (HAART) is associated with facial lipoatrophy, which is potentially stigmatizing for HIV-positive patients. We assessed the long-term effects of polyalkylimide gel injections on the severity of lipoatrophy and quality of life of patients on HAART. A prospective study was performed of 17 HIV-positive patients with grade 2 and grade 3 facial lipoatrophy. A mean volume of 14 cc of polyalkylimide gel (Bio-Alcamid) was injected subcutaneously at one or more sites of the face in a single stage. Each patient was seen for follow-up after 3, 12, 24, and 48 weeks. The severity of lipoatrophy and the quality of life was assessed using a self-report questionnaire containing the relevant parts of the SF-36, MOS-HIV, and CES-D. The severity of facial lipoatrophy decreased significantly from baseline over 48 weeks. Quality of life improved significantly from baseline over 48 weeks for mental health and social functioning. Depression at week 48 was significantly correlated with the extent to which lipoatrophy had disappeared at week 48. Individualized volumes of polyalkylimide gel injected in one session significantly decreased the subjective severity of lipoatrophy and improved the quality of life of HIV-positive patients with grade 2 and 3 lipoatrophy, even in the four patients who had complications.