4-Year
Study Finds Polyacrylamine Hydrogel (Aquamid) Facial Filler Is a Safe and Satisfactory
Treatment for Lipoatrophy By
Liz Highleyman  Although
less common now than in the earlier years of the AIDS epidemic, facial
lipoatrophy, or fat loss, remains a distressing condition that can interfere
with treatment adherence. The chief characteristics of facial lipoatrophy
are sinking of the cheeks, eyes, and temples due to loss of subcutaneous fat.
Lipoatrophy may resemble AIDS-related wasting, but most studies show that
it is linked to certain nucleoside/nucleotide
reverse transcriptase inhibitor (NRTI) antiretroviral drugs, most commonly
stavudine (d4T, Zerit), which is
no longer a recommended drug for first-line treatment.
Lipoatrophy cannot
be "cured" -- although slow improvement often occurs after the associated
drugs are discontinued -- but there are several cosmetic treatments including
facial fillers and implants.
In
the April 2009 issue of AIDS Research and Human Retroviruses, Eugenia Negredo
of Universitat Autonoma de Barcelona in Spain and colleagues presented findings
from a long-term study of one such filler, polyacrylamide hydrogel, marketed as
Aquamid.
The study included 145 participants, 62% of whom had severe facial
lipoatrophy at baseline. About 80% were men. The average age was 47 years, the
average duration of HIV infection was 16 years, and the mean duration of exposure
to antiretroviral therapy was 9 years.
Participants received facial "infiltrations"
(injections) of Aquamid between September 2002 and April 2004. The amount of filler
used and the number of infiltrations (administered every 3 weeks) were individually
tailored based on lipoatrophy severity.
Investigators collected epidemiological
and clinical data, information about antiretroviral therapy use, psychological
data related to patient satisfaction (very satisfied, satisfied, or not satisfied),
side effects, and occurrence of local infections at any time after receiving the
filler.
Results
The cumulative volume of Aquamid injected was 5.5 mL per person (range 4-18 mL).
The most frequent complications were small, palpable but invisible nodules (occurring
in 19.3% of patients) and indurations, or hard lumps (occurring in 6.2%).
During an average 50 months of follow-up after Aquamid administration, only 1
patient developed a local bacterial infection near the injection site (successfully
treated with antibiotics).
When including the remaining 294 patients at the center who also received Aquamid
more recently (less than 4 years ago), 3 additional people developed a local infection
(incidence rate of 0.9%).
Most patients (88.9%) reported that they were "satisfied" or very satisfied"
with the results of Aquamid treatment.
Patients who had mild to moderate facial lipoatrophy at baseline were more satisfied
than those with severe lipoatrophy (92.7% vs 86.5% reporting "very satisfied").
17.4% of the patients said they still had some lipoatrophy remaining after Aquamid
treatment.
Only 9.2% of study participants required additional Aquamid infiltrations, but
76.0% said they would have preferred more.
Based
on these findings, the study authors concluded, "The high patient satisfaction
and the low number of severe complications after at least 4 years of facial infiltrations
with Aquamid reflect the long-term safety of this product for the repair of facial
lipoatrophy."
However, they cautioned, "prolonged follow-up of
these patients is recommended to detect unexpected long-term adverse reactions."
The
results of this study are encouraging because some other facial fillers require
periodic re-administration to maintain their effect. The most widely used filler
for facial lipoatrophy is polylactic acid, marketed as New Fill in Europe and
Sculptra in the U.S.
Lluita contra la SIDA Foundation, Germans Trias
i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona,
Spain. 5/05/09 Reference
E
Negredo, J Puig, D Aldea, and others. Four-year safety with polyacrylamide hydrogel
to correct antiretroviral-related facial lipoatrophy. AIDS Research and Human
Retroviruses 25(4): 451-455. April 2009. (Abstract).
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