Poly-L-Lactic Acid Injection for HIV-Associated Facial Lipoatrophy: Treatment Principles, Case Studies, and Literature Review

Abstract

Most HIV-positive patients receiving highly active antiretroviral therapy develop facial lipoatrophy soon after commencing treatment. Attempts to correct lipoatrophy through autologous fat transfer or the use of temporary, semipermanent, or permanent fillers have achieved some benefits, but either do not have lasting effects, do not treat some areas effectively, or have other disadvantages. The purpose of this article is to outline the treatment principles for use of poly-L-lactic acid (PLLA) in HIV-associated facial lipoatrophy since its emergence in 1999 and review the relevant literature, with particular emphasis on investigations of the incidence of subcutaneous papule formation after PLLA treatment. The principles of treating facial lipoatrophy with PLLA, including product preparation, patient preparation, and injection technique, are reviewed. Two case studies and results are presented as typical examples of treatment and results. A literature discussion focuses on changes in the incidence of papule formation after PLLA treatment. In the representative cases presented, 2 white men in their forties with facial lipoatrophy who had been HIV-positive for more than 10 years received 2 vials of PLLA in each of 5 treatments spaced 4 weeks apart. Results are shown 4 weeks after the final treatment. No papules were reported in the 12-month follow-up period. Early investigations of PLLA for the treatment of HIV-associated facial lipoatrophy reported a significantly high incidence of subcutaneous papule formation. As experience with PLLA has increased, the incidence of papule formation has dropped dramatically. The proper dilution, adequate hydration time, proper placement of the product, sufficient intervals between treatments, and posttreatment massage all have contributed to this decrease.