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Autologous fat transfer for the treatment of HIV-related face lipoatrophy: 1-year follow-up
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7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005, Dublin, Ireland
G Guaraldi 1, G Orlando1, D De Fazio2, A Rottino2, A Grisotti 2, M Blini 2, V Borghi1, G Nardini1 and R Esposito1
1University of Modena and Reggio Emilia, Italy; 2 San Raffaele
Hospital, Milan, Italy/Casa di cura S. Pio X, Milan, Italy
ABSTRACT 46
Antiviral Therapy 2005; 10:L30
Objectives: The aim of this study was to analyse the longterm subjective and objective efficacy and durability of autologous fat transfer (AFT) for the treatment of HIVrelated facial atrophy in a sample of people reaching 48 to 96 weeks of follow-up.
Methods: Among 151 HIV-infected patients undergoing AFT for the treatment of facial lipoatrophy, 41 reached a follow up between 48 and 96 weeks and have been analysed. Subjective satisfaction for the aesthetic result was assessed with a 0 to 10 visual analogue scale (VAS); objective efficacy and durability with ultrasound evaluation of dermal plus subcutaneous cheek thickness. Assessment of Body Change and Distress questionnaire (ABCD with its subscales: body image satisfaction, BIS, and psychological and social distress, PSD) was utilized to evaluate satisfaction with body image and the distress for the psychological and social consequences of lipodystrophy.
Results: Patients' baseline characteristics were: 17, 47.2% female, mean age 44.4 ±7.2 years, 22% CDC group C, mean CD4 nadir 186 ±128 cells/ml, CD4+ cells at surgery 629 ±346 cells/ml, median HIV-VL at surgery 2.83 ±1.26 log/ml.
--Fat graft was harvested from subcutaneous abdominal fat in all the cases.
--Eight patients (22%) underwent polylactic acid injections to have aesthetic
retouch.
Only patient one needed a reintervention to reach the final desired result.
--In the follow up VAS improved from 2.80 ±1.65 to 5.60 ±2.29 P=0.001.
--Ultrasound evaluation showed an increase in cheek thickness (right cheek
thickness from 5.33 ±2.85 mm to 8.32 ±3.31 P<0.0001, left cheek thickness from 5.53 ±2.79 mm to 8.46 ±3.23 P<0.0001).
--ABCD showed an improvement in body image satisfaction (BIS scores from 4.18 ±0.66 to 3.73 ±0.82, P=0.029), while the distress for the consequences of lipodystrophy on psychosocial life reduced without reaching a statistically significant difference (PSD scores from 61.81 ±16.01 to 65.12 ±15.58, P=0.302).
Conclusions: Our results showed that autologous fat transplant is effective and durable over time for correction of facial lipoatrophy in HIV-infected people, even if a considerable number of patients needed a retouch with filler implants to optimize the aesthetic results. The presence of mixed forms of fat redistribution could explain the lack of a significant improvement in ABCD PSD scores.
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