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

Injectable Poly-l-Lactic Acid: A Novel Sculpting Agent for the Treatment of Dermal Fat Atrophy After Severe Acne

Acne vulgaris affects up to 80% of people 11 to 30 years of age, and scarring can occur for up to 95% of these patients. Scarring may be pitted or hypertrophic in nature, although in most cases it is atrophic. Atrophic acne scarring follows dermal collagen and fat loss after moderate to severe acne infection. Injectable poly-L-acid (PLLA) is a biocompatible, biodegradable, synthetic polymer device that is hypothesized to enhance dermal volume via the endogenous production of fibroblasts and, subsequently, collagen. The gradual improvements in cutaneous volume observed after treatment with injectable PLLA have been noted to last up to 2 years. The case studies presented describe the use of injectable PLLA to correct dermal fat loss in macular atrophic acne scarring of the cheeks. Two female patients underwent three treatment sessions with injectable PLLA over a 12-week period. At each treatment session, the reconstituted product was injected into the deep dermis under the depressed portion of the scar. Both patients were extremely pleased with their results at, respectively, 1- and 4-year follow-up evaluations. Patients experienced minimal swelling and redness after injection and no product-related adverse events such as papule and/or nodule formation. The author believes these data suggest that injectable PLLA is a good treatment option for the correction of macular atropic scarring with thin dermis (off-label use), particularly compared with other injectable fillers currently used for this indication that have shorter durations of effect

High-density hyaluronic acid for the treatment of HIV-related facial lipoatrophy

Facial lipoatrophy is a stigmatizing hallmark of HIV. The injection of facial fillers has an essential role in the treatment of this condition. The objective of our study was to verify the safety and efficacy of a new formulation of high-density hyaluronic acid for the injectable treatment of HIV-related facial lipoatrophy.We treated with high-density hyaluronic acid injections HIV patients affected by moderate to severe facial lipoatrophy and evaluated them at last follow-up, at a minimum of 36 weeks. Physician-related outcomes included pre-and post-treatment ultrasound measurement of the soft-tissue thickness of the cheeks and qualitative assessment of aesthetic results by means of the Global Aesthetic Improvement Scale using pre- and post-treatment photos of the patients. Patient satisfaction outcomes were evaluated with the VAS-face scale and Freiburg test.Fifty-four patients were studied. The median number of treatment sessions was 3 and the median length of treatment was 5.5 months. The thickness of the soft tissues of the cheek increased significantly from 9.45 to 13.12 mm (p<0.0001). On the basis of the Global Aesthetic Improvement Scale, 87.5% of the patients were judged as "much improved" or "improved." Patient satisfaction at 1 year from the end of treatment was proven (VAS-face: 77.9; Freiburg questionnaire: 93.6% of patients were satisfied or very satisfied). Complications were limited to mild redness and swelling in the early postoperative period.Long-term improvement of facial contour and excellent patient satisfaction, in the absence of severe side effects, were obtained by the injection of high-density hyaluronic acid (STYLAGE\uae XL) in HIV patients with facial lipoatrophy

Effectiveness of Protease Inhibitor Monotherapy versus Combination Antiretroviral Maintenance Therapy: A Meta-Analysis

The unparalleled success of combination antiretroviral therapy (cART) is based on the combination of three drugs from two classes. There is insufficient evidence whether simplification to ritonavir boosted protease inhibitor (PI/r) monotherapy in virologically suppressed HIV-infected patients is effective and safe to reduce cART side effects and costs

Infectious Complications in HIV-infected Kidney Transplant Recipients

Renal transplantation is now a viable alternative for dialysis in HIV-infected patients who achieve good immunovirological control with current antiretroviral therapy regimens available. However, there are few studies that analyze the incidence of post-transplant infections in this population. In this study, a retrospective analysis of data files of 24 HIV-infected kidney transplant (KT) recipients was undertaken, matched to 21 non-infected controls. All patients received induction with anti-interleukin-2 antibodies and were followed in the Pitié-Salpêtrière Hospital in Paris, France. The rate of incidence of post-transplant infections was 23.58 and 26.98/100 patient-years, in HIV-infected and HIV-negative groups (relative risk [RR]: 0.90; 95% confidence interval [CI]: 0.58\textendash 1.39; p\,=\,0.63). In HIV-infected KT recipients, bacterial infections were the most frequent (67.7%), followed by viral (14.7%) and fungal and parasitic infections (8.8%). Similar trends were seen in the control group. Incidence of opportunistic infections was similar in HIV-infected KT recipients and controls (38.2 vs. 26.5%; p\,=\,0.44). There were three post-transplant HIV reactivations in two patients, secondary to poor adherence to medication. HIV status did not influence survival, but infections increased the risk of unfavorable outcome. Incidence of post-transplant infections was similar in HIV-infected KT recipients and controls. Infections, but not HIV status, had adverse effects on patient and graft survival

Prévalence de l’infection par le VIH et le virus de l’hépatite C chez les personnes détenues en France. Résultats de l’enquête Prévacar 2010

International audienceThe prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among prison inmates in France in 2010 was evaluated in a cross-sectional study based on a two-stage design. Sampling favoured larger establishments and included all types of prisons. Establishments were stratified by geographical region. Estimates were adjusted by post-stratification of the total population of inmates in France. From 60,975 inmates in 188 prisons on the sampling day, 2,154 were selected from 27 prisons, and 1,876 questionnaires completed. HIV prevalence was estimated at 2.0% (95% confidence interval (CI):0.9-4.2), 2.6% (95% CI: 0.7-8.8) in women and 2.0% (95% CI:0.9-4.3) in men; 75% of HIV positive inmates werereceiving treatment for HIV. HCV prevalence was estimated at 4.8% (95% CI:3.5-6.5) and was higher for women (11.8%; 95% CI:8.5-16.1) than men (4.5%; 95% CI:3.3-6.3). Almost half of HCV-infected inmates had chronic hepatitis C and 44% were receiving or had received treatment for HCV. HIV and HCV prevalence was six times higher than in general population, and 2.5% of inmates had viraemic hepatitis C. The moment of incarceration provides an ideal opportunity for testing and treating these infectious diseases, limiting their spread and improving patients’ prognosis.La prévalence du VIH et de l’hépatite C a été estimée en 2010 chez les personnes détenues en France à partir d’une étude transversale s’appuyant sur un plan de sondage à deux degrés (tirage des établissements pénitentiaires puis des individus). Les estimations sont redressées à l’ensemble des personnes détenues par post-stratification sur l’âge, le sexe, le continent de naissance et la région de l’établissement. Parmi les 60 975 personnes détenues en mai 2010 dans 188 établissements pénitentiaires, 2 154 individus ont été tirés au sort dans 27 établissements. La prévalence du VIH  était estimée à 2,0% (IC95%:[0,9-4,2]), et était plus élevée chez les femmes (2,6% ; IC95%:[0,7-8,8]) que chez les hommes (2,0% ; IC 95%:[0,9-4,3]) ; 75% des personnes détenues porteuses du VIH recevaient un traitement pour leur infection. La prévalence du VHC était estimée à 4,8% (IC95%:[3,5-6,5]) et était plus élevée chez les femmes (11,8% ; IC95%:[8,5-16,1]) que chez les hommes (4,5% ; IC95%:[3,3-6,3]). Près de la moitié des personnes infectées par le VHC avaient une hépatite chronique (ARN du VHC positif) et 44% avaient reçu ou recevaient un traitement pour le VHC. La prévalence du VIH et du VHC était six fois plus élevée  en milieu carcéral qu’en population générale et 2,5% des personnes détenues étaient virémiques (charge virale positive) pour le  VHC. Le dépistage et la prise en charge de ces pathologies infectieuses pendant l’incarcération sont essentiels pour en limiter la transmission et améliorer le pronostic de ces patients