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Background:  Polylactic acid has been used for the treatment of facial lipoatrophy due to HAART  for several years. However, the long-term efficacy of this treatment is not well established.

Method:  Patients with a sustained control of HIV infection (CD4 count >200/mm³ and plasma viral load <20,000 copies/mL for at least 3 months) were injected with polylactic acid in the derm of both cheeks. Injections of polylactic acid mixed with xylocaďne were done every 15 days. Efficacy of the treatment was assessed using a standardized quality of life questionnaire, an analogic visual scale satisfaction index (graded 1/10 to 10/10), and tridimentionnal photographs of the face for 50 patients. After superimposition, these photographs were analyzed by a software calculating the maximal thickness increase at the site of injections. The safety of the treatment was assessed at each visit.

Result :  A total of 94 patients (88 males, 6 females) received polylactic acid injections. Mean age was 43 years (30 to 64). CDC clinical stages were A in 90% of cases, B in 6%, and C in 4%. All patients, but 4, were under HAART (D4T containing regimen in 40% patients). Median CD4 count was 500/mm³.  Plasma HIV RNA was below 200 copies/mL in 71% of cases. Median follow-up was 12 months. Median number of injections per patient was 5 and median injected volume was 2.5 mL per cheek. Median analogic visual scale satisfaction index increased from 3.4 (baseline) to 6.8 after the completion of the procedure and was maintained, 7.5 months later, at 7. No significant variation of quality of life was noted. Median dermal thickness increase in both cheeks was 2 mm after 2 injections, and 2.3 when measured 7 months after the last injection. Seven patients experienced  malaise after the first injection. Grade 1 or 2 pain was noted in 80% of patients. Non-inflammatory small nodules in the injected area were detected in 12 patients (11.7%). Minor bleeding was noted in 4 patients. In 1 patient, the treatment was stopped after the first injection because of an anaphylactic reaction, possibly related to the injection. No specific treatment was required.

Conclusions:  After a mean follow-up of 12 months in 94 patients, intradermal injections of polylactic acid appeared to be safe with a long-lasting increase in analogic visual scale satisfaction index.

Keywords: lipoatrophy; polylactic acid; HIV