Hyaluronic Acid Treatment of Facial Fat Atrophy in HIV-positive Patients

H Bugge; A Negaard; L Skeie; B Bergersen


HIV Medicine. 2007;8(8):475-482. 

In This Article


Twenty-seven patients applied to take part in the study. Six patients were not included because of minimal facial changes, and one was excluded because of previous injections of hyaluronic acid. Twenty patients, one female and 19 male, were enrolled between September 2004 and April 2005 and are included in the study analysis. At baseline, the patients were 49±7 years old and their mean weight was 74.7±10.0 kg. They had a long history of HIV infection; the duration from the first positive test was 13.6 years (minimum 8.5 and maximum 20.0 years), and the mean time on antiretroviral therapy was 10.0 years (minimum 6.9 and maximum 15.6 years). All but one patient had been on stavudine (mean time on stavudine 40±27 months) and 17 had stopped taking stavudine at least 1 year before inclusion. Details about the use of zidovudine were not included. The patients' HIV infection was well controlled; the mean CD4 count was 520±320 cells/μL and 14 (70%) had HIV RNA < 50 copies/mL.

Mean (±standard deviation) total cutaneous thickness increased from 6±1 mm at baseline to 15±3 mm at week 6 (P<0.001), and declined to 10±2 mm at week 52 (P<0.001 vs baseline) (Fig. 2). The response rate, defined as total cutaneous thickness >10 mm, was 100% at week 6. In the intention-to-treat analysis, the response rate was 85% at week 24 (17/20; one patient missing) and 60% at week 52 (12/20; two patients missing).

When evaluating the effect of treatment using the Global Aesthetic Improvement Scale at week 6, all of the patients classified their facial appearance as very much or moderately improved ( Table 1 ). At week 52, 15 of the 19 remaining patients classified their facial appearance as very much improved or moderately improved. Thirteen patients wanted touch-up treatment at week 52.

At 6 weeks, patient visual analogue assessments and self-esteem scores had increased significantly from baseline ( Table 2 ). Significant improvements on visual analogue and self-esteem scores, although somewhat reduced, persisted through to week 52.

There were no serious adverse effects and no treatment interruptions because of side effects. Most patients experienced some local swelling and tenderness on the first 1-3 days following treatment and some had local redness ( Table 3 ). Eight of the patients had palpable lumps after one or two treatments. Some of these were visible and in three of the patients the lumps were still present at week 52. One lump was localized at the injection site and was movable (Fig. 5a). Another patient reported fever, redness, swelling and vesicles on his right cheek 2-3 days after treatment. He recognized the vesicles as recurrent herpes zoster and self-treated with acyclovir. Following the touch-up treatment at week 4, he had a similar reaction (this time without vesicles) on his left cheek (Fig. 3). These changes were evaluated by the physician as reactive and noninfectious and resolved after 2-3 days without medical treatment.

Total cutaneous thickness at baseline and 6 weeks after hyaluronic injection.

Each patient required approximately 6 mL of Restylane SubQ in the baseline treatment including touch-up. Thirteen patients had a refill treatment at week 52 which was similar to the baseline treatment (about 6 mL including touch-up at week 56). With the full price for 1 mL of Restylane SubQ being €160 (including taxes and blunt-tip application cannulas; no discount), the yearly cost of filling material (approximately 6 mL) can be estimated to be approximately €950.

Reactive reaction 2-3 days after injection with hyaluronicacid.

Clinical change following hyaluronic acid injections in four patients at baseline and week 6.


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