Deep subcutaneous application of poly-L-lactic acid as a filler for facial lipoatrophy in HIV-infected patients

Introduction: Facial lipoatrophy is a crucial problem of
HIV-infected patients undergoing highly active antiretroviral
therapy (HAART). Poly-L-lactic acid (PLA), provided as
New-Fill(R)/Sculptra(TM), is known as one possible treatment
option. In 2004 PLA was approved by the FDA as Sculptra(TM) for the
treatment of lipoatrophy of the face in HIV-infected patients.
While the first trials demonstrated relevant efficacy, this was to
some extent linked to unwanted effects. As the depth of injection
was considered relevant in this context, the application modalities
of the preparation were changed. The preparation was to be injected
more deeply into subcutaneous tissue, after increased dilution.
Material and Methods: To test this approach we performed a pilot
study following the new recommendations in 14 patients. Results:
While the efficacy turned out to be about the same, tolerability
was markedly improved. The increase in facial dermal thickness was
particularly obvious in those patients who had suffered from
lipoatrophy for a comparatively small period of time. Conclusion:
With the new recommendations to dilute PLA powder and to inject it
into the deeper subcutaneous tissue nodule formation is a minor
problem. However, good treatment results can only be achieved if
lipoatrophy is not too intense; treatment intervals should be about
2 - 3 weeks. Copyright (C) 2005 S. Karger AG, Basel.