Assessment of the safety and efficacy of
poly-L-lactic acid for the treatment of HIV-associated
Cheryl M. Burgess, MD, and Rafaela M. Quiroga, MD
Background: Lipodystrophy syndrome is uniquely associated with the use of highly active antiretroviral
therapy (HAART) containing protease inhibitors or nucleoside reverse transcriptase inhibitors. Between
15% and 80% of patients on HAART develop facial lipoatrophy within 10 months of initiating therapy. At
present, no ideal treatment strategies have emerged in spite of the psychosocial stress, resulting in
depression and isolation in many HIV-infected patients. Most soft tissue fillers seem to be well tolerated;
however, various reactions such as allergic reactions, infection, and inflammatory and allergic
Luxembourg) is currently being used in Europe and is approved by the Food and Drug Administration
(FDA) in the United States for soft tissue augmentation in HIV-associated facial lipoatrophy.
Objective: To determine the safety and efficacy of PLA for dermal enhancement of facial lipoatrophy in
immuncompromised HIV-infected patients with prior use of HAART.
Methods: Sixty-one immunocompromised, HIV-infected male patients (52 whites, 7 African Americans, 1
Latino, and 1 Asian) underwent multiple treatment sessions with PLA over a 5-month period for facial
lipoatrophy. The severity of facial lipoatrophy was assessed and photographs were taken at baseline and
before each treatment session. Periodic monitoring for adverse reactions and degree of improvement were
assessed by the patient, the treating physician, and a non-treating physician.
Results: At the 6-month follow-up, all 61 immunocompromised HIV patients had a successful outcome,
defined as smoothing of the skin with less concavities or depressions, and improved overall appearance in
an average of 3 treatment sessions. Although all patients were very pleased with their results, two patients
developed persistent asymptomatic palpable intradermal papules in the infraorbital region as a result of the
site of placement and concentration of PLA. On long-term follow-up (18 months), 48 of 61 (79%) required
an average of 3 visits to achieve the desired enhancement and 13 of 61 (21%) patients requested additional
treatment sessions beyond the initial 3 sessions. Although the patient and the physicians rated the level of
improvement as ‘‘Excellent,’’ the desire for further dermal enhancement was purely subjective. In general,
the procedures were well tolerated without the clinical development of adverse reactions.
Conclusion: The use of PLA to treat facial lipoatrophy resulted in significant and prolonged improvement
in HIV-infected patients. The effect was long lasting, for up to 2 years in some patients, depending on when
treatment was initiated. There were no reported cases of infection, allergies, or serious adverse reactions,
and the treatment was well tolerated. ( J Am Acad Dermatol 2005;52:233-9.)
HIV-associated lipodystrophy syndrome and treat-
ment with protease inhibitors (PIs), and a number of
nucleoside reverse transcriptase inhibitors (NRTIs)
may also be involved.1,2In addition to clinical
findings such as lipoatrophy and fat redistribution,
many agree that alterations in the lipid profiles
and glucose intolerance are included within the
lthough lipodystrophy syndrome has been
proven difficult to define and the etiology is
From the Center for Dermatology and Dermatologic Surgery.
Funding sources: None.
Conflicts of interest: None identified.
Accepted for publication August 30, 2004.
Reprint requests: Cheryl M. Burgess, MD, Center for Dermatol-
ogy and Dermatologic Surgery, 2311 M Street, Northwest, Suite
ª 2005 by the American Academy of Dermatology, Inc.
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