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Session 147 Poster Abstracts
Clinical Studies of Hyperlipidemia, Fat Redistribution, and Glucose Metabolism
Thursday, 1:30 - 3:30 pm
Hall B


851    
Subcutaneous Polylactic Acid in HIV-1-associated Facial Lipoatrophy: Clinical and Spiral CTScan Outcome as Predictors of Response
Anne Mijch*, C Bowtell-Harris, B Archer, and J Hoy
Alfred Hosp, Melbourne, Australia

Background:  Loss of facial subcutaneous fat is a distressing durable component of the lipodystrophy syndrome for some HIV-infected individuals treated with combination ART, and treatment options are few. Methods:  We report the 6-month outcome of an open-label study of subcutaneous injection of polylactic acid (PLA) in 27 individuals, with moderate to severe facial thinning. Primary efficacy measure is facial atrophy assessed by independent plastic surgical review of standardized clinical photography (baseline and 6 months post-treatment). Secondary efficacy measures include patient-scored changes in facial thinning, and changes in facial soft-tissue volume on Spiral CT scan (baseline and 4 months post treatment), quality of life and HIV treatment outcome (adherence). Adverse events were assessed by patient questionnaires at end of treatment and at 6 months.

Results:  Of 27 individuals, 20 patients’ self-assessment indicated improvement in facial appearance at 6 months (concordance with photography grading –48.1%). Age, baseline CD4 cell count, and type of ART did not predict the degree of facial improvement. Facial volume (cm3 ± SD) prior to 140.9 (16.3) and after 149.3 (16.3) correlated with photographic grade at baseline and follow-up, patient distress at baseline but not at follow-up. Psychological/emotional distress was reported as substantially reduced in those with photographically as well as patient self-assessed improved appearance. Local pain was recorded by 63% of individuals, mean severity 3.4/10; redness by 74%, mean severity 3.7/10; and swelling by 89%, mean duration 2.4 days, severity 4.04/10. No patient withdrew because of adverse events.

 

 

Severity Lipoatrophy Score

Mean (SD)*

Patient Distress Score

Mean (SD)*

 

Photograph

Graded by Plastic Surgeon

Patient assessment grade

 

Baseline

2.9 (0.9)

3.6 (1.1)

3.9 (1.2)

Month 6

   2.3 (1.0)**

   2.6 (1.3)**

    2.9 (1.7)**

 

* Six point grade 0=nil, 5=severe.

 

 

 

** Difference from baseline P < 0.05

 

 

Conclusions:  Subcutaneous injection of PLA produced durable improvement over 6 months in facial appearance in 74% of these individuals with moderate to severe facial atrophy. Spiral CT-scan volume provided a quantifiable measure of severity. Few adverse events were recorded and patients’ distress was markedly improved.

Keywords: Lipodystrophy; Subcutaneous Polylactic Acid Therapy; Facial Spiral CTscan