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Facial Lipodistrofia In Patients Living with HIV/AIDS: From Diagnosis to The Necessary Interventions.

Copyright@ Elcio Magdalena Giovani
This work is licensed under Creative Commons Attribution 4.0 License
Department of Dentistry, Brazil University, Brazil
  Elcio Magdalena Giovani, Chairman, Professor, Integrated Clinic Discipline, Coordinator of Center for
Studies and Special Service for Patients, Professor, Postgraduate Dentistry Courses, UNIP, São Paulo, SP, Brazil.
To Cite This Article: Elcio Magdalena Giovani. Facial Lipodistrofia In Patients Living with HIV/AIDS: From Diagnosis to The Necessary
Interventions. Am J Biomed Sci & Res. 2019 - 4(3). AJBSR.MS.ID.000795. DOI: 10.34297/AJBSR.2019.04.000795
R : July 18, 2019 | : July 29, 2019
American Journal of
Biomedical Science & Research
Literature Review
In HIV/AIDS patients using high-potency antiretroviral
therapy, from their Advent, in mid-1996, a series of new anatomical
and metabolic changes began to be observed, mainly in showing
atrophy of peripheral fat, as well as accumulation of central fat, and
simultaneously, it was noted that the redistribution of body fat was
accompanied by insulin resistance and several abnormalities in
serum lipids. These alterations were described and denominated
as lipodystrophy and/or lipodystrophy HIV syndrome (SLHIV).
At the time of the initial diagnosis of lipodystrophic syndrome,
2 years after the introduction of protease inhibitors (PI), however,
it coincides with the inclusion of a second nucleoside analog
reverse transcriptase inhibitor, stavudine. Initially, SLHIV was
were observed after the use of Crixivan® (indinavir), an IP class
medicine. Subsequently, the association between the use of
indinavir and the redistribution of body fat is observed, described
after the initial diagnosis of the syndrome, described in 1998,
where with the imagological resources, the utilization of computed
tomography was used, Demonstrating the increase in visceral fat in
these individuals. Following the chronological order of time, new PI
appear, and clinical and laboratory evidence was observed that the
redistribution of body fat was not an exclusive effect of indinavir,
and this denomination was abandoned. Nowadays, several
synonyms are used for SLHIV, such as body fat redistribution
syndrome, metabolic syndrome associated with antiretroviral
therapy, or, more recently, dyslipidemic lipodystrophy associated
with HIV/HAART [1-7].
  
them the moststriking were perceived in the face of the accumulation
of fat inthe abdominal region and in the posterior part of the neck,
called the Gibas. Other important anatomical alterations point
to the lipoatrophy of the face, the upper and lower limbs and a
      
fats in the region of the abdomen, cervical region and breasts. One
of the most used methods to determine a case of lipodystrophy
includes the subjective description of changes in body fat, and then
The advent of Aids has brought new challenges to the health area and the dentist surgeon plays an important role in the management of these
patients. Antiretroviral therapy has dramatically changed the morbidity and mortality associated with HIV/Aids infection but has contributed to
the emergence of other new situations that require proper approach. Lipodystrophic Syndrome Associated with HIV/AIDS is of multifactorial origin
but is strongly associated with the use of antiretrovirals. It comprises alterations in the distribution of body fat, accompanied or not by metabolic
alterations. The loss of facial fat, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome. This condition, often revealing the
disease, brought back the stigma of AIDS, leading patients to depression and total seclusion of their daily life activities. It is necessary that Dental Sur-
geons always share with the multidisciplinary team working with HIV/AIDS patients to identify these changes and seek effective and recommended
treatment options for the treatment of facial lipoatrophy associated with HIV/AIDS.
HIV/AIDS Patients; Lipodystrophic Syndrome; Lipodystrophy; Facial Lipoatrophy
Am J Biomed Sci & Res Copyright@ Ewa Filip
some diagnostic criteria are proposed, among them the clinicians
described as face-back, temples Depressed, clotted eyes, prominent
zygomatic arch, slimed aspect, prominent non-varicose veins
in arms and legs, loss of skinfolds, loss of contour and fat of the
gluteal region. The accumulation of fat is categorized into 5 areas,
such as: increased abdominal circumference, pectoral enlargement,
buildup of dorsal-cervical fat, accumulating facial fat, and the
presence of lipomas. The methods for evaluation and monitoring of
fat include patient complaint, clinical assessments, anthropometric
measurements and imaging exams.
The lack of standardized values in relation to fat in the general
population and the heterogeneity of the clinical manifestations of
        
methods that have been used are effective and recommended, such
as Anthropometry, bio impedance, DEXA, computed tomography,
magnetic resonance imaging and ultrasonography. Anthropometry
and Impedanciometry are not able to measure regional fat, but the
use of Ultrasound becomes important and promising, in the face of
its simplicity of not being invasive, and low cost. Epidemiologically
lipodystrophy is extremely variable among HIV patients, using
antiretroviral therapy (ART) for at least one year [1,3,6,8-10].
The metabolic alterations are detected and among them are
understood the lipid alterations and abnormalities in glucose
homeostasis, and they can still be associated or not the anatomical
alterations and the lipid alterations found in the SLHIV, which
Are the increase in serum triglyceride levels (GCT) and/or total
cholesterol. Hypertriglyceridemia is mainly due to the high rates of
new lipogenesis and delayed clearance of GCS in the postprandial
    
IP, have increased serum levels of Fasting of Apoliproteins B and E,
possibly by increased synthesis of the same, which could be related
to the manifestation of hyperlipidemia.
Glucose abnormalities may manifest as glucose intolerance,
peripheral insulin resistance or diabetes mellitus (DM), and
the mechanisms of action by which ARVS, such as protease
inhibitors, cause insulin resistance, are the Reduction of insulin-
mediated glucose uptake in skeletal musculature and adipocytes,
affecting glucose metabolism by producing imperfect peroxisome
proliferator-activated gamma receptor (PPAR-gamma) expressions.
Nucleoside analogous reverse transcriptase inhibitors mainly
cause lactic acidosis occurring in the syndrome. Moreover,
secondary to mitochondrial dysfunction due to the inhibition of
the deoxyribonucleic acid (DNA) Mitochondrial polymerase by this
class of drugs. The establishment of lactic acidosis is slow and the
Metabolic alterations are associated with increased risk of
cardiovascular events. Hyperinsulinemia associated with insulin
resistance and a recognized risk factor in HIV-infected patients
and may contribute to the increased risk of acute myocardial
infarction in patients receiving ARV. Thus, HIV-positive patients,
         
glycemia and triglycerides and low levels of HDL cholesterol, have
an increased risk of atherosclerosis, coronary disease and diabetes
mellitus, which is evident as an expressive pathology associated
with lipodystrophic syndrome in patients living with HIV/Aids
[1,3-6, 11-13].
There are proposals for adequate interventions for patients
with facial lipoatrophy to be established and shared by the
multidisciplinary team (dentist, clinical physician, infectologist,
endocrinologist, dermatologist, plastic surgeon, Nutritionist,
physical educator), being:
a) Change the medication: in a patient receiving HIV
treatment with ARVs such as Zidovudine or stavudine, it is
recommended to exchange for a nucleoside analogue such as
Abacavir, and in patients using PROTEASE inhibitor to evaluate
its substitution by an Integrase inhibitor as Dolutegravir.
b) Dietary changes: food restructuring replacing all excesses
by low fat and carbohydrate diet.
c) Drug treatment with metformin, glyazones and or human
recombinant leptin.
d) Hormonal treatment: Use of supplements and hormones
should be evaluated with caution due to the risk of drug
interaction and increased risk of hepatitis.
e) Physical activities: Implement physical activity routines
preferably at least 3 times a week.
f) Cosmetic Treatments: Facial reconstruction with free
or even the edentulous, show considerably improvements in the
conditions of deformities caused by facial lipoatrophy, alleviating
the losses, Patient’s facial region [14-19].
Facial Lipoatrophy
Among the areas affected by lipoatrophy, one of the most
frequent components of the syndrome, the face is the region in
which fat loss is more evident and impactful. Facial lipoatrophy is
malar fat called Bichat ball and temporal fat, consequently implying
the emergence of new skin grooves and the accentuated increase of
Expression Grooves, In addition to areas of depression and evidence
of bone structure, which is why it leads to a wrinkle of the face and
gives the individual an aspect of premature aging and, in women,
the loss of facial fat leads to a loss of the femininity of the face, and
the aspect of the face in A “disease facies”, returning the stigma
of the “face of Aids”, in addition to the fear of the unintentional
revelation of the diagnosis [3,20-23].
        
resulting from aging caused by alterations in the soft tissues and
fat loss occurring in HIV-associated lipoatrophy, suggest that it
is lower in aging than that observed in people With Lipoatrophy.
However, with advances in the treatment of Aids and the reduction
Am J Biomed Sci & Res Copyright@ Ewa Filip
of morbidity and mortality, consequently there was an increase in
life expectancy and, increasingly, we will have the combination of
these two factors (aging and lipoatrophy) interfering directly in the
contour Patients living with HIV/Aids.
Another worrying and currently detected factor is the loss of
bone mineral density that is part of the same syndrome, and is
        
maintaining special care for dental surgical procedures Avoiding
intimely conducts exerting the proposed activities with lightness
and safety avoiding fractures and other traumas to the patient,
besides the same for the success of the surgical indication of the
placement of dental implants, which may be associated with
avascular necrosis, it also has to be considered as an important
complication of SLHIV, since hyperlipidemia and the infection itself
by HIV are known risk factors for osteonecrosis of the femoral head
and in mandibles [1,4,20,24].
In the present moment, it evidences a certain tendency of Aids
       
the administration of antiretroviral drugs, its use can accelerate
        
life in those who Develops. To improve the quality of life of the
patient, when the dentist and or the multidisciplinary team itself
point to the aforementioned diagnosis of these patients with
facial lipoatrophy, it is necessary for the patient to be welcomed,
forming an important bond with him in order to receive a look,
and special attention and multidisciplinary preference, and ensure
the dental treatment, replacing the losses of the dental elements, a
factor that decreases the Flattening and or even the sinking caused
by lipoatrophy, rescuing the aesthetics, chewing and phonetics,
considerably improving the appearance and the posterior when
necessary and with indication for each case as a complementary
completing and correcting the marks of facial lipoatrophy. One of
       
also botulinum toxin (Botox®) and hyaluronic acid [1,25-29].
The Facial lipoatrophy Index (ILA) was developed an
instrument that aims to measure the degree of atrophy and the
degree of improvement with the treatment, in an objective way. The
ILA evaluates 3 regions of the face, which are:
1) Malar region that corresponds to the areas of the
zygomatic and buccal regions, having as limits the infraorbital
border and the lower edge of the mandible; The zygomatic
bone, the projection of the mandible body, the major zygomatic
muscle, the canine fossa and the maxilla.
2) Temporal region corresponds to the anterior portion of
the temporal fossa, limited by the temporal line of the frontal
bone and the zygomatic arch.
3) The Preauricular region corresponds to the Masseterin
region, between the zygomatic arch and the angle and the lower
edge of the mandible.
The depth and extent of the affected area in the malar, temporal
and pre-auricular regions are evaluated separately. The depth of the
atrophic areas is scored from 0 to 4, being 0 as absence of atrophy,
1 mild depth, 2 moderates, 3 being severe and 4 very severe. The
extent of the affected area is scored from 0 to 5, being 0 as absence
of impairment, 1 impairment less than 20% of the evaluated region,
2 from 21 to 50%, 3 from 51 to 70%, 4 from 71 to 90% and 5 from
91 to 100%. A partial number is calculated for each area evaluated,
multiplying the score relative to the depth by the score relative
to the affected area and still by a correction factor. Since fat loss
is not symmetrical, it is considered the most affected side in the
      
lipoatrophy in grades I to IV, from the application of the ILA. Being
grade I, or mild facial lipoatrophy, and in these cases, there is a
slight depression, but there is no evidence of anatomical accidents
in the region or loss of facial contour. Grade II, or moderate,
is characterized by depression, and is more visible with the
onset of the visualization of anatomical accidents, especially the
zygomatic arch and the increase of the nasolabial sulcus. Grade III,
or severe, where the Malar region’s accidents are observed, such
as the zygomatic bone, visualization of the canine fossa, partial
visualization of the major zygomatic muscle, and mild or moderate
depression of the lower edge of the mandible. Loss of facial contour
and jaw projection may occur. The degree IV, or very severe, and
there is almost complete visualization of the anatomical contours,
revealing the bone and muscular framework of the face. There is
loss of facial contour, with visualization of the upper and lower faces
of the zygomatic arch in the temporal and preauricular regions.
       
all with a degree of subjectivity for being evaluator dependent
Final Considerations
With the introduction of high-potency antiretroviral treatment
(HAART), in people living with HIV/Aids (PVHA) important and
determinant factors such as the decrease in morbidity and mortality
and increased life expectancy, with higher quality, began to make
Some of the achievements acquired in these years, but on the other
hand, a series of adverse events related to the use of medications
have been reported. Several clinical signs and symptoms have been
described since then and grouped as Lipodystrophic syndrome,
which is characterized by anatomical and metabolic alterations,
and may occur in isolation or associated form. Metabolic
alterations comprise a serum increase in lipids (cholesterol and
triglycerides), increased peripheral resistance to insulin, changes
in bone trabeculate, type I diabetes mellitus, associated or not with
anatomical alterations. These, in turn, derive from the redistribution
of body fat, which may result in loss (lipoatrophy) or accumulation
Lipoatrophy occurs in the region of the face, upper and
lower limbs and buttocks. Lipohypertrophy occurs in the
abdomen, cervical region and breasts. Dentists together with the
multidisciplinary team reveal an important role in this context,
as they achieve within their area of knowledge to mitigate these
adverse effects of lipoatrophy, as they perform an effective treatment
Am J Biomed Sci & Res Copyright@ Ewa Filip
Dentistry, mainly by replacing the loss of dental elements that
automatically associated with lipoatrophy, somatize irreparable
damage. But the placement of oral prostheses replenishing the
dental losses, rescuing the loss of the vertical dimension, the
phonetics, the aesthetics, and carefully adjusting the prostheses
         
toxin, polymethacrylate and other available options that jointly
mitigate all procedures the deleterious effects of facial lipoatrophy.
These alterations in the body contour negatively affect mainly the
psychosocial health of people living with HIV/Aids, who may have
their seropositivity revealed by these remarkable characteristics,
which intensify the stigma in relation To the disease, strengthening
prejudice, impacting social and affective relationships, directly
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This study examined the effects of perceived discrimination on the well-being of people with HIV and the mediating role of self-exclusion as a function of the participants' symptoms of lipodystrophy. An ex post facto study with a sample of 706 people with HIV was conducted. Self-perception of lipoatrophy and lipohypertrophy, perceived discrimination, self-exclusion and psychological well-being were measured. Results of hier-archical cluster analysis showed participants could be categorized into three groups: no lipodystrophy, mixed syndrome with predominant lipoaccumu-lation and lipoatrophy. Results of structural equation modeling revealed that the negative effects of perceived discrimination on well-being were mediated to a large extent by self-exclusion. Invariance analysis revealed that the mediating role of self-exclusion was not the same in the three clus-ters. Complete mediation of self-exclusion in the groups without lipo-dystrophy and with predominant lipoaccumulation was confirmed. Regard-ing lipoatrophy, the negative effects of perceived discrimination were greater and only partly mediated by self-exclusion. In conclusion, having lipodystrophy exposed people to more discrimination; lipoatrophy was the most stigmatizing condition.
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Background Many Africans who are on life-saving ART face challenges from a variety of toxicities. After the introduction of a standardized first-line efavirenz-containing ART regimen, reports of gynecomastia appeared in Malawian popular media, however data on the prevalence and risk factors of gynecomastia from Africa are lacking. Methods We conducted a cross–sectional study in males ≥18 years registered on ART at the HIV clinic in Zomba Central Hospital. Men who reported to have ever experienced breast or nipple enlargement received a standard questionnaire and underwent physical examination. Questions included perceptions and concerns about gynecomastia. Clinicians confirmed the presence and severity of gynecomastia. Routinely collected data on current and previous ART regimens, CD4 count, WHO clinical stage, anthropometric measurements and history of tuberculosis were extracted from the electronic database. Results We enrolled 1,027 men with median age 44 years (IQR: 38–52). The median ART duration was 57 months (IQR: 27–85); 46.7% were in WHO stage III/IV at ART initiation, 88.2% had exposure to efavirenz and 9% were overweight or obese. The prevalence of self-reported gynecomastia was 6.0% (62/1027) (95%-CI: 4.7–7.7%). Of men with gynecomastia 83.6% reported nipple enlargement and 98.4% enlarged breasts (85.5% bilateral). One-third said they had not reported gynecomastia to a health care worker. Over three-quarters mentioned that gynecomastia was an important or very important problem for them, while more than half were embarrassed by it. On examination gynecomastia was present in 90% (confirmed gynecomastia prevalence 5.5%; 95%-CI: 4.2–7.0%) and 51.8% had severity grade III or IV. History of tuberculosis treatment was independently associated with self-reported gynecomastia, adjusted OR 2.10 (95%-CI: 1.04–4.25). Conclusions The burden of gynecomastia among men on ART in Malawi was higher than previously reported, and was associated with adverse psychological consequences, calling for increased awareness, a proactive diagnostic approach and diligent clinical management.
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Quality of life (QoL) is an important component in the evaluation of the wellbeing of people living with HIV/AIDS (PLHIV).This study was aimed at evaluating the QoL of PLHIV attending the antiretroviral clinics in the Ho municipality. A cross-sectional study was conducted from January 2017 to April 2017 involving 158 purposively selected HIV-positive patients who were attending the antiretroviral clinics both in the Volta Regional Hospital and Ho Municipal Hospital. An Interviewer administered standard questionnaire (WHOQOL-HIV Bref) was used to collect information on sociodemography, medical history, and the quality of life (QoL) of the respondents. Among these 158 HIV-positive respondents, 126 (79.75) and 14 (8.86) presented with excellent and good overall QoL, respectively, whilst 18 (11.39) had their life negatively affected by HIV/AIDS.Religious/ personal beliefs (19.62%) were the most affected QoL component, followed by the physical (15.82%) and level of independence (15.19%) domains. Patients’ occupation, perception of health, sexual activity, and state of the disease were associated with poor overall QoL. In general, being an HIV-infected man, symptomatic patient, not being sexually active, or being ART naıve was also associated with poorer QoL in several HIV/AIDS QoL domains.
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Background Aim of this review is to focus the attention on people living with HIV infection at risk of developing a cardiovascular event. What is or what would be the most suitable antiretroviral therapy? Which statin or fibrate to reduce the risk? How to influence behavior and lifestyles? Discussion Prevention of cardiovascular disease (CVD) risk remains the first and essential step in a medical intervention on these patients. The lifestyle modification, including smoking cessation, increased physical activity, weight reduction, and the education on healthy dietary practices are the main instruments. Statins are the cornerstone for the treatment of hypercholesterolemia. They have been shown to slow the progression or promote regression of coronary plaque, and could also exert an anti-inflammatory and immunomodulatory effect. However the current guidelines for the use of these drugs in general population are dissimilar, with important differences between American and European ones. The debate between American and European guidelines is still open and, also considering the independent risk factor represented by HIV, specific guidelines are warranted. Ezetimibe reduces the intestinal absorption of cholesterol. It is effective alone or in combination with rosuvastatin. It does not modify plasmatic concentrations of antiretrovirals. A number of experimental new classes of drugs for the treatment of hypercholesterolemia are being studied. Fibrates represent the first choice for treatment of hypertriglyceridemia, however, the renal toxicity of fibrates and statins should be considered. Omega 3 fatty acids have a good safety profile, but their efficacy is limited. Another concern is the high dose needed. Other drugs are acipimox and tesamorelin. Current antiretroviral therapies are less toxic and more effective than regimens used in the early years. Lipodistrophy and dyslipidemia are the main causes of long-term toxicities. Not all antiretrovirals have similar toxicities. Protease Inhibitors may cause dyslipidemia and lipodystrophy, while integrase inhibitors have a minimal impact on lipids profile, and no evidence of lipodystrophy. There is still much to be written with the introduction of new drugs in clinical practice. Conclusions Cardiovascular risk among HIV infected patients, interventions on behavior and lifestyles, use of drugs to reduce the risk, and switch in antiretroviral therapy, remain nowadays major issues in the management of HIV-infected patients.
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Introduction Human immunodefiecency virus infected patients did not adhere correctly to their Antiretroviral Therapy because of the drugs adverse effects. Thus, continuous evaluation of the adverse effect of Antiretroviral Therapy will help to make more effective treatment. The aim of this study was to assess the prevalence of Adverse Drug Reaction and associated factors on Antiretroviral Therapy among Human immunodefiecency virus infected Adults at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Methods A Hospital based retrospective study was conducted among 358 of adult patients clinical records on antiretroviral Therapy from April1 to June30, 2014. Results The overall prevalence of Adverse Drug Reaction among Human immunodefiecency virus infected patients on antiretroviral Therapy was 17.0%. Of reported Adverse Drug Reaction, 80.3%, 18% and 1.7% occurred in patients on Stavudine, Zidovudine and Tenofovir based regimens respectively. The common Adverse Drug Reaction were lipodystrophy (fat change) (49.2%), numbness/tingling (27.9%), peripheral neuropathy (18%) and (8.2%) anaemia (8.2%). Patients on Stavudine containing regimens were more likely to develop Adverse Drug Reaction compared to Zidovudine (AOR = 0.212, 95% CI 0.167, 0.914, p<0.001) and Tenofovir (AOR=0.451, 95% CI 0.532, 0.948, p<0.001). Conclusion The overall prevalence of Adverse Drug Reaction among Human immunodefiecency virus infected patients in this study was 17% and more common on those patients taking Stavudine based regimen. Lipodystrophy and peripheral neuropathy were significantly associated with stavudine-based regimens, while anaemia was significantly associated with zidovudine based regimens. Thus regular clinical and laboratory monitoring of patients on Antiretroviral Therapy should be strengthened.
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Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review. Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.
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Progression of lipodystrophy syndrome is a big challenge in HIV treatment. Nowadays, fat loss at the lower part of buttocks has become another problem as patients have started to complain that it is painful to be seated for a long time and/or on hard surfaces. We developed a method for buttock lipoatrophy treatment with PMMA-microspheres, as silicone prostheses and autologous fat transplant were not completely efficient. The treatment consisted of net-crossed injections, in the subcutaneous layer, of a 30% PMMA-microspheres solution on the atrophic areas of the buttock. One hundred and fifty-four patients were included. The amount of PMMA-microspheres used to treat buttock lipoatrophy depended on the degree of atrophy and size of the area to be treated. Patients were satisfied with this treatment and reported to be more comfortable to be seated for longer period of time. We demonstrated that soft tissue augmentation with PMMA-microspheres is safe and efficient for the treatment of buttock lipoatrophy associated with HIV lipodystrophy.
Background: The use of combination antiretroviral therapy (cART) has significantly decreased the morbidity and mortality associated with human immunodeficiency virus (HIV) infection. Lipid disorders, including lipodystrophy, hypertriglyceridemia, and hypercholesterolemia, remain the most commonly reported metabolic disorders among those treated with long-term cART. Mounting evidence suggests an association between drug abuse and poor glycemic control and diabetes complications. Substance related disorders (SRD) may increase the risk of metabolic syndrome. Materials and methods: The aim of this retrospective cohort study was to examine the relationship between SRD, cART, and lipid-lowering agent use in an HIV infected population. Patients received efavirenz or protease inhibitor-based cART for at least 6 months. Prescription information was retrieved from the medical records. The primary outcome was the use of lipid-lowering agents including statins, fibrates and fish oil. The impact of SRD and cART was assessed on the lipid-lowering agent use. Results: A total of 276 subjects with HIV infection were included, 90 (33%) received lipid-lowering agents, and 31 (34%) had SRD. Smoking was prevalent among subjects with SRD (84 vs 15%, p<0.001). Statins were the mainstay for the management of dyslipidemia (66%), followed by the fibrates (24%), omega-3 fatty acids (5%), nicotinic acid (3%) and the cholesterol absorption inhibitors (3%). Use of statins or fibrates was significantly higher among subjects without SRD than those with (40 vs 23%, p=0.005). The type of cART, including efavirenz and protease inhibitors, appeared to have no significant impact on the use pattern of lipid-lowering agents. Lopinavir/ritonavir (lopinavir/r) was mostly prescribed for subjects with SRD (25 vs 8%, p=0.02). Conclusion: Among HIV-infected patients, statins remain the mainstay for the management of dyslipidemia in routine clinical care, followed by fibrates. A significant high risk of metabolic disorders among patients with SRD is implicated by heavy tobacco use and prevalent lopinavir/r-based treatment. Significantly low rate of lipid-lowering agent use in this population underscores the importance of lipid disorder scrutiny and cART treatment optimization for HIV-infected patients with SRD.
Combination antiretroviral therapy (CART) reduces the mortality and morbidity in HIV-infected patients. However, facial lipoatrophy (FLA) is one of the well-known side-effects of this treatment and subsequently imposes major problems for HIV-infected patients. In the last decade, ample experience has been obtained with both local therapeutic options as well as possible systemic treatment options. Soft tissue fillers are a relatively simple and efficient treatment option for FLA. Especially, the biodegradable semi-permanent fillers combine a good effect with durability and an acceptable safety profile. The best way to prevent or restrict the development of FLA remains the exclusion of thymidine analogue nucleoside reverse-transcriptase inhibitors from the CART schedule.
Highly active antiretroviral therapy (HAART) improves the longevity of HIV patients. However, the side effect of the drugs leads to development of chronic metabolic and cardiovascular complications. The aim of the study was to determine the prevalence and risk factors of the metabolic abnormalities and lipodystrophy among adult Ethiopian HIV infected patients on ART for one year and above. A cross-sectional study was conducted among HIV infected patients on HAART for one year or more, attending the ART clinics of Tikur Anbessa Specialized hospital in Addis Ababa. A total of consecutive 356 HIV infected patients volunteered to participate in the study from July 2007 to January 2008. Data was collected using clinical interview technique on structured questionnaires and physical examination of the patient, 319 had biochemical tests performed. Three hundred fifty six HIV patients; 261 (73.1%) females and 95 (26%) males were studied. Two hundred nine (59.7%) patients were on Stavudine based and 135 (41.3%) were on Zidovudine based ART therapy. The overall prevalence of lipodystrophy was 68.3% (243), prevalence of hyperlipademia among 319 HIV patient was 56.9% Among these, the prevalence of hypercholesterolemia was 38.2%, high LDL cholesterol was 54.2% hypertryglyceredimeia was 15.2% Fasting hyperglycemia was 17.8% (IFG in 10.9% and overt diabetes in 6.9%). History of smoking was significantly associated with lipoatrophy and lipohypertrophy. ART regimen d4T was significantly associated with lipoatrophy. Duration of ART treatment > or = 1 yr was significantly associated with both lipoatrophy, lipohypertrophy and hypertriglyceredemia. Lipodystrophies occurred in majority of patients on ART treatment for longer than one year, hyperlipaedemia and hyperglycaemia were also seen commonly in Ethiopian HIV patients on HAART. We recommend careful monitoring of metabolic abnormalities, examination of the patient for early detection of the side effect, change of the offending agents management of metabolic abnormalities.