Psychological morbidity and facial volume in HIV lipodystrophy: Quantification of treatment outcome

SummaryHIV lipoatrophy is a stigmatizing condition associated with significant psychological morbidity. The aim of this study was to evaluate change in facial volume and psychological morbidity following treatment with autologous fat, Sculptra® and Bio-alcamid®.MethodsHIV LD patients were treated based on a clinical assessment in a prospective, observational study. 3-D images were obtained pre-operatively then at 2, 6 and 12 months post-operatively using the DI3D system. Volume changes were measured using DI3D software. The DAS-24 and HADS were used to assess psychological morbidity at similar time intervals.ResultsForty-eight patients with HIV LD were treated: 16 patients had Bio-alcamid®, 20 patients received Sculptra® and 12 patients underwent fat transfer. The mean injected volume of Bio-alcamid® was 25.5 cc which was comparable to the measured volume change at follow-up. The mean injected volume of fat was 20.1 cc, which did not differ from the measured volumes at 2 months. There was a mean reduction in measured volume change to11.2 cc at 6 months and 10 cc at 12 months.For Sculptra®, the mean volume change compared to baseline was 8.7 cc at 2 months, increasing to 12.6 cc at 6 months and 12.3 cc at 12 months.ANOVA tests demonstrated no difference in psychological outcomes between groups. There was a significant improvement in DAS-24 scores compared to baseline for all 3 groups. No correlation between change in facial volume and psychological measures was demonstrated.ConclusionsChange in 3-D measured facial volume for all 3 groups was seen. Treatment was associated with improved body image perception.