Fillers for HIV-Associated Lipoatrophy
Keywords:
HIV lipoatrophy; poly-L-lactic acid; facial fillers; calcium hydroxylapatite; antiretroviral therapy.Abstract
Introduction: HIV-associated lipoatrophy causes disfiguring facial volume loss. This review compares long-term safety and efficacy of permanent vs. temporary fillers. Methods: Eight studies (n=416) with ≥12 months follow-up. Fillers: poly-L-lactic acid (PLLA), calcium hydroxylapatite (CaHA), and polymethylmethacrylate (PMMA). Results: PLLA required 3-4 sessions but produced sustained improvement at 24 months (95% patient satisfaction). CaHA gave immediate results but resorption by 12 months (70% maintained). PMMA (permanent) had highest rate of late granulomas (12%) requiring intralesional steroids. Discussion: HIV patients may have altered immune responses to filler materials. Study heterogeneity in outcome measures (ultrasound, patient report) limited direct comparison. Conclusions: PLLA is preferred for HIV lipoatrophy due to good durability and low granuloma risk. Permanent fillers are discouraged.
