Fat microinfiltration autografting for facial restructuring in HIV patients

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Summary

Introduction

Antiretroviral drugs used to treat HIV infection are closely associated with faciocervical and peripheral lipodystrophies. There are several options for surgical treatment of facial lipodystrophy, one of these was described by S. R.Coleman in 1994, the technique of fat transplantation.

Material and methods

A retrospective study of 23 seropositive patients is presented, who were treated according to Coleman's technique. The surgical procedure was evaluated by clinical and CT analysis. The longest follow-up was 3 years.

Results

The technique was well tolerated from both a clinical and psychological point of view. 74% were successful. Multiple fat transplantation procedures were required to obtain a satisfactory result for the remaining patients. No complications were observed.

Discussion

Coleman's method is very simple. It is performed without using any biomaterial. There are aesthetic and social benefits for the patients. A limitation of this procedure is that some patients do not have enough fat at the donor site.

Conclusion

The results of this procedure after a maximum of 3 years postoperatively have been positive. However, there is a need of long-term experience with this method.

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.

Section snippets

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:

  • 14 men and 9 women;

  • mean age 44 years (30–66 years);

  • mean HIV duration before surgery 8 years (4–15 years of seropositivity)

  • one patient presented a HIV–HBV co-infection and two patients had a HIV–HCV co-infection;

  • 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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