Fat microinfiltration autografting for facial restructuring in HIV patients
Introduction
Antiretroviral drugs used to treat HIV type 1 infection may induce faciocervical and peripheral lipodystrophies (Carr et al., 1999; Shevitz et al., 2001; Heath et al., 2001). There usually is a facial lipoatrophy, related to resorption of Bichat's fat pad that is characterized by a temporal, preauricular and malar depression. On the other hand, sometimes there is a cervical hypertrophy leading to the typical buffalo's hump appearance. Several surgical techniques have been used to treat facial lipoatrophy. In 1950, Peer described autologous fat transplantation. In 1989, Fournier presented the method of lipofilling, and in 1991 Coleman developed a technique by using centrifugation (Coleman, 1995). Although Coleman's technique is widely applied, there are not many reports concerning the HIV population. A report on 23 HIV-seropositive patients is presented covering a period of 3 years: all patients were affected by lipoatrophy secondary to protease inhibitor therapy, and were surgically treated using Coleman's technique.
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Patients and Methods
Between January 1999 and December 2002, 23 HIV-patients treated by protease inhibitors were surgically treated according to Coleman's technique. The characteristics of the study group were:
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14 men and 9 women;
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mean age 44 years (30–66 years);
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mean HIV duration before surgery 8 years (4–15 years of seropositivity)
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one patient presented a HIV–HBV co-infection and two patients had a HIV–HCV co-infection;
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apart from therapy with a protease inhibitor, 13 patients were treated in addition with lamivudine,
Results
Facial lipoatrophy appeared 2 years on average after the beginning of antiretroviral therapy. Nine patients presented a cheek lipoatrophy; 11 patients had both cheek and temporal lipoatrophy, and 3 other patients presented with jugal, temporal and preauricular lipoatrophy. In 5 cases an associated hypertrophy was diagnosed (4 patients with a buffalo hump and 1 had an infracostal lipoma).
The plasma HIV RNA level was undetectable in 7 cases, with the remaining patients having had a HIV copy count
Discussion
There is to date only one study evaluating Coleman's technique in patients with HIV-related facial lipoatrophy up to now (Caye et al., 2003). That study population was similar to this one (a series of 29 patients of 43 years average age, with a 5 year history of HIV disease prior to surgery). Whilst those authors did not describe preauricular lipoatrophy, there were 3 cases with a significant preauricular lipoatrophy (13% of the patients) in this study.
We therefore proposed a lipoatrophy scale
Conclusion
The aesthetic and social problems affecting HIV-seropositive patients can be treated by fat transplantation according to Coleman. Satisfactory results have been observed using this procedure, with no complications observed.
Results have been consistent and reproducible during several studies. Assessments of postoperative results were essentially based on clinical evaluation.
The limitation of this procedure is that some patients do not have enough subcutaneous fat to transfer.
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