Safety and Efficacy of a Volumizing Hyaluronic Acid Filler for Treatment of HIV-Associated Facial Lipoatrophy

IMPORTANCE Facial lipoatrophy (FLA) is associated with human immunodeficiency virus (HIV) disease and the use of highly active antiretroviral therapy. The condition is primarily characterized by facial volume loss that affects the contours of the cheeks, temples, and orbits and may negatively affect patients' adherence to highly active antiretroviral therapy, psychological health, and quality of life. A single treatment of hyaluronic acid (HA) filler, 20 mg/mL, may provide an immediate, natural-appearing facial enhancement outcome. OBJECTIVE To evaluate the safety and efficacy of an HA filler for treatment of HIV-associated FLA during a 12-month follow-up. DESIGN, SETTING, AND PARTICIPANTS Open-label, safety and efficacy study in patients with HIV-associated FLA, a Carruthers Lipoatrophy Severity Scale (CLSS) grade of 2 or greater (range, 1-4, with higher scores indicating greater severity), and no previous treatment for FLA during the past year received 1 treatment and an optional touch-up. Twenty patients were treated and followed up at the Sacramento Veterans Affairs Medical Center, Mather, California, from March 5, 2015, to May 17, 2016. INTERVENTIONS Midface (cheeks and temples) volumization was performed using the "smile-and-fill," fanning, and depot technique with an optional touch-up at the 2-week follow-up. MAIN OUTCOMES AND MEASURES Patients underwent evaluation at the initial visit and follow-up at 2 weeks and 3, 6, 9, and 12 months. Main outcome measures included safety (rate of treatment-related adverse events), CLSS grade, and Global Aesthetic Improvement Scale rating (5-point scale, ranging from worse to very much improved). RESULTS Nineteen of the 20 patients (all men; mean [SD] age, 57 [10] years) completed all study visits. Baseline HIV-associated FLA severity was CLSS grade 2 in 16 patients; grade 3, in 3 patients; and grade 4, in 1 patient. The total mean (SD) volume of HA used was 6.1 (3.1) mL for grade 2 FLA; 9.3 (4.2) mL for grade 3 FLA; and 26.0 (0) mL for grade 4 FLA (1 mL equals 1 syringe of HA filler). All 19 patients maintained a significant improvement of CLSS (grade 1) and Global Aesthetic Improvement Scale rating (very much improved) with no treatment-related adverse events at 12 months. CONCLUSIONS AND RELEVANCE This study reports excellent safety and efficacy and supports use of this HA filler for treatment of HIV-associated FLA with durable results at 12 months. Future multicenter, randomized clinical trials with blinded independent investigators are needed to demonstrate the long-term safety, efficacy, and durability of this HA filler for treatment of HIV-associated FLA.