1
|
Temporal Trend and Clinical Outcomes in HIV and Non-HIV Patients following Liposuction: A Propensity-Matched Analysis. Plast Reconstr Surg 2023; 151:47e-55e. [PMID: 36205655 DOI: 10.1097/prs.0000000000009795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Because of the availability of highly active antiretroviral therapy, individuals infected with human immunodeficiency virus (HIV) are enjoying greater longevity with chronic conditions including abnormal adipose distribution. However, prior data on postoperative outcomes of liposuction in HIV-positive patients were limited by small sample size. Therefore, the authors aimed to compare differences in temporary trend, clinical characteristics, and outcomes between patients with and without HIV who underwent liposuction. METHODS The National Inpatient Sample database from 2010 to 2017 was queried to identify patients who underwent liposuction. Univariate, multivariate logistic regression and 1:4 propensity score-matched analyses were used to assess the primary outcomes (i.e., in-hospital mortality and postoperative outcomes) and secondary outcomes (i.e., discharge disposition, prolonged length of stay, and total cost). RESULTS Overall, 19,936 patients who underwent liposuction were identified, among whom 61 patients (0.31%) were infected with HIV. Patients with HIV were more likely to be male, insured by Medicare, and had more comorbidities and lower income. Unadjusted length of stay was longer among patients with HIV (OR, 1.81; 95% CI, 1.09 to 2.99; P = 0.020); nevertheless, multivariable models and propensity score-matched analysis demonstrated that patients with HIV were no more likely to have complications than the general population. This was also the case for length of stay and total costs. CONCLUSIONS The authors' findings indicated that patients with HIV who underwent liposuction did not experience an increased risk of major complication or mortality. Liposuction could be safely considered as a surgical treatment for HIV-positive patients with local fat deposition. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
Collapse
|
2
|
Wang G, Zhao J, Zhang X, Yang S, Zhang W, Xie H. Liposuction to improve the dorsocervical fat pad in esthetic need: Anatomical study and clinical case series. J Cosmet Dermatol 2022; 21:5942-5951. [PMID: 35866350 DOI: 10.1111/jocd.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients are undergoing surgery to relieve the prominent dorsocervical fat pad because of their esthetic needs. OBJECTIVE To determine their clinical needs, it is necessary to research the clinic, radiography, and anatomy of dorsocervical fat pad. METHODS The occipital fat thickness, dorsal fat thickness, and the length, width, and thickness of the dorsocervical fat were measured through MRI imaging. Body projection position were recorded. The correlation between the body mass index and dorsocervical hump was analyzed. Anatomical and histological studies of cadavers with a dorsocervical hump were performed. The liposuction for dorsocervical fat pad was introduced and patients were followed up. RESULTS In measurement, the MRI imaging of 109 patients were evaluated. The average length, width, and thickness of the dorsocervical fat pad were 114.47, 89.24, and 23.46 mm, respectively, and it is commonly located from the 3rd cervical vertebra to the 3rd thoracic vertebra. The average dorsocervical ratio was 151%. 43.1% patients had a dorsocervical hump. Based on the protrusion degree, the dorsocervical fat pad was classified into three types. The dorsocervical hump severity had a low correlation with obesity. In anatomy, 4 cadavers were dissected. The histological staining indicated that two layers of fat pad constituted a dorsocervical fat pad. As for treatment, 34 patients underwent liposuction to improve the dorsocervical contour, all of them reported satisfactory outcome. CONCLUSIONS The histological manifestations and morphological measurement of dorsocervical fat pad is researched. Besides, liposuction was applied in 34 patients with dorsocervical hump, and had received satisfied outcome.
Collapse
Affiliation(s)
- Guanhuier Wang
- Department of Plastic Surgery, Peking University 3rd Hospital, Beijing, China
| | - Jianfang Zhao
- Department of Plastic and Burn Surgery, Peking University First Hospital, Beijing, China
| | - Xinling Zhang
- Department of Plastic Surgery, Peking University 3rd Hospital, Beijing, China
| | - Shan Yang
- Department of Plastic Surgery, Peking University 3rd Hospital, Beijing, China
| | - Weiguang Zhang
- Department of Anatomy, Histology and Embryology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Hongbin Xie
- Department of Plastic Surgery, Peking University 3rd Hospital, Beijing, China
| |
Collapse
|
3
|
Excisional lipectomy versus liposuction in HIV-associated lipodystrophy. Arch Plast Surg 2021; 48:685-690. [PMID: 34818717 PMCID: PMC8627937 DOI: 10.5999/aps.2020.02285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy. Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed. Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation. Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.
Collapse
|
4
|
Chen S, Gui XE, Cao Q, Routy JP. Clinical outcome after lipectomy in the management of patients with human immunodeficiency virus-associated dorsocervical fat accumulation: An observational cohort study. Medicine (Baltimore) 2019; 98:e16112. [PMID: 31232958 PMCID: PMC6636914 DOI: 10.1097/md.0000000000016112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Lipo-accumulation of the dorsocervical fat pad ("buffalo hump") is a complication observed in people living with human immunodeficiency virus (HIV). We described the clinical outcome of people living with HIV with "buffalo hump" treated by excisional lipectomy.From April 2013 to March 2018, medical records of people living with HIV, who received care in our hospital have been evaluated. Among them, patients with dorsocervical fat accumulation treated by excisional lipectomy have been retrospectively assessed.Nine patients with "buffalo hump" among 2886 people living with HIV (3.1‰, 9/2886) were included. Eight were women with a mean age of 47.9 ± 8.0 years old (range, 36-60). Most of them have been infected by blood transfusion (77%, 7/9) and the mean duration of HIV infection was 14.1 ± 5.5 years (range, 6-22). The mean duration for antiretroviral therapy was 8.8 ± 2.1 years (range, 6-11). The mean pre-ART CD4+ T cell count was 91.3 ± 76.5 cells/μL (range, 4-233) and 477.4 ± 271.8 cells/μL (range, 114-926) at the time of surgery. All 9 patients underwent excisional lipectomy of their hypertrophied dorsocervical fat pad. The mean size of the excised specimens was 14 × 11 × 6 cm. The median follow-up time was 24 months (range, 2-60), all 9 patients reported satisfaction with their results, with no recurrence has been observed.Corrective surgery used to treat localized fat accumulations in people living with HIV with "buffalo hump" showed a favorable effect and can therefore be considered when necessary. Whereas drugs such as integrase inhibitors may avoid lipo-accumulation related syndrome and should be given to people living with HIV in China.
Collapse
Affiliation(s)
- Song Chen
- Department of Urology
- Department of Biological Repositories
| | - Xi-en Gui
- Training Center of AIDS Prevention and Cure of Hubei Province
| | - Qian Cao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jean-Pierre Routy
- Division of Hematology, and Chronic Viral Illness Service, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Facelift in a patient with benign symmetric lipomatosis and HIV facial lipoatrophy: a case report. Ann Plast Surg 2016; 73:266-7. [PMID: 24051469 DOI: 10.1097/sap.0b013e31827a3022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Benign symmetric lipomatosis (BSL) is a rare condition characterized by deposition of unencapsulated adipose tissue at typical sites on the body. Although the pathogenesis is not clearly defined, the disease has been associated with male gender, alcoholism, Mediterranean descent, and highly active antiretroviral therapy. A case study is presented of a facelift performed on a human immunodeficiency virus-positive patient on a highly active antiretroviral therapy with facial lipoatrophy in the anterior cheek region in combination with BSL characterized by excess fat deposits in multiple areas including the posterior cheeks and neck. The resultant peculiar deformity was managed in this case with a modified facelift and fat excision without recurrence. There are few reports in the English literature describing surgical excision using the facelift pattern for treating BSL.
Collapse
|
6
|
Tsui E, Bogdasarian R, Blomain E. The successful use of lipectomy in the management of airway obstruction in a woman with HIV-associated lipodystrophy. BMJ Case Rep 2015; 2015:bcr-2014-208053. [PMID: 25694636 DOI: 10.1136/bcr-2014-208053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lipodystrophy is a common complication of highly active antiretroviral therapy and is associated with significant comorbidities. Altered fat distribution, particularly lipohypertrophy of the dorsal cervical fat pad is associated with reduced quality of life as well as medical complications. We report the rare case of a patient with airway obstruction secondary to HIV-associated lipodystrophy. Ultrasound-assisted liposuction was successfully performed to relieve her airway obstruction and to facilitate a tracheostomy. To the best of our knowledge, this is the first documented case of its kind. We also provide a brief review of the literature on the current management options for HIV-associated lipodystrophy.
Collapse
Affiliation(s)
- Edison Tsui
- The Commonwealth Medical College, Scranton, Pennsylvania, USA
| | | | - Eric Blomain
- The Commonwealth Medical College, Scranton, Pennsylvania, USA
| |
Collapse
|
7
|
Abstract
When prescribed appropriately and taken adherently, antiretroviral therapy can consistently and durably suppress HIV replication, potentially translating into years of near normal health for HIV-infected persons. However, presently available antiretrovirals are associated with a cluster of physical and metabolic symptoms termed HIV lipodystrophy. This article reviews the state of knowledge about the pathogenesis and treatment of the various manifestations of these adverse effects.
Collapse
Affiliation(s)
- Stephen Kravcik
- Department of Medicine, Ottawa Hospital/University of Ottawa, 501 Smyth Road, Ottawa, Ontario, Canada K4M 1K3.
| |
Collapse
|
8
|
Bonnet E. New and emerging agents in the management of lipodystrophy in HIV-infected patients. HIV AIDS (Auckl) 2010; 2:167-78. [PMID: 22096395 PMCID: PMC3218685 DOI: 10.2147/hiv.s13429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Lipodystrophy remains a major long-term complication in human immunodeficiency virus-infected patients under antiretroviral (ARV) therapy. Patients may present with lipoatrophy or lipohypertrophy or both. The choice of treatments to improve fat redistribution depends on the form of lipodystrophy and its duration. Measures known to improve lipoatrophy are switches in ARV therapy (stavudine or zidovudine to abacavir or tenofovir) and filling interventions. Pioglitazone may be added to these measures, although any benefits appear small. Uridine and leptin were found to be disappointing so far. Regarding lipohypertrophy, diet and exercise, recombinant human growth hormone, and metformin may reduce visceral fat, but may worsen subcutaneous lipoatrophy. Surgical therapy may be required. Attractive pharmacologic treatments include growth hormone-releasing factor and leptin. Adiponectin and adiponectin receptors are promising therapeutic targets to explore.
Collapse
Affiliation(s)
- Eric Bonnet
- Service des Maladies Infectieuses, Hôpital Purpan, Toulouse, France
| |
Collapse
|
9
|
Early Results Using Ultrasound-Assisted Liposuction as a Treatment for Fat Necrosis in Breast Reconstruction. Plast Reconstr Surg 2010; 126:762-768. [DOI: 10.1097/prs.0b013e3181e5f870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Mar GJ, Durbridge J. Human immunodeficiency virus (HIV)-associated lipodystrophy and difficult intubation. Anaesthesia 2009; 64:1261. [PMID: 19825071 DOI: 10.1111/j.1365-2044.2009.06114.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Sharma D, Bitterly TJ. Buffalo hump in HIV patients: surgical management with liposuction. J Plast Reconstr Aesthet Surg 2009; 62:946-9. [DOI: 10.1016/j.bjps.2007.10.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 10/29/2007] [Accepted: 10/31/2007] [Indexed: 11/26/2022]
|
12
|
Gulizia R, Vercelli A, Gervasoni C, Uglietti A, Ortu M, Ferraioli G, Galli M, Filice C. Comparability of echographic and tomographic assessments of body fat changes related to the HIV associated adipose redistribution syndrome (HARS) in antiretroviral treated patients. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1043-1048. [PMID: 18308461 DOI: 10.1016/j.ultrasmedbio.2007.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 10/21/2007] [Accepted: 12/14/2007] [Indexed: 05/26/2023]
Abstract
To assess the comparability of ultrasonographic (US) subcutaneous fat thickness (SFT) measurements in comparison with computed tomography (CT) at reference points (RPs) representative of HIV related adipose redistribution syndrome (HARS) in patients treated with antiretrovirals. US and CT measurements were compared in nine patients with clinical reports of HARS. We obtained the best resolution of facial (at deepest point of Bichat pad), brachial (in the dorsal face of arm) and crural SFT (at mid thigh) by means of minimal transducer pressures avoiding potential biases such as stand off pads pressure on the skin and artefacts due to too abundant quantity of gel. CT scans were obtained in the same RP where US measurements were performed such as identified by means of metallic skin markers. Median US measurement of facial SFT was 8.8 mm (95% CI: 3.1 to 13.4), 3.95 mm (95% CI: 2.62 to 5.84) for brachial SFT and 4 mm (95% CI: 3.4 to 9.4) for crural SFT. Median CT assessments of facial SFT was 8.7 mm (95% CI: 3.5 to 13.5), 4.2 mm (95% CI: 2.6 to 5.88) for brachial SFT and 5 mm (95% CI: 3.9 to 10.3) for crural SFT, with no significant difference at each RP. A linear regression showed good CT/US comparability at each RP, with no significant deviation from linearity (p > 0.10). US shows to be highly comparable with CT, excluding invaliding biases as the transducer pressure on the skin. Given the proven efficacy on the HARS assessments, if well standardized, US could be a reliable method, simpler than CT in the management of body fat changes related to HARS.
Collapse
Affiliation(s)
- Rosario Gulizia
- Division of Infectious and Tropical Diseases, Foundation IRCCS S Matteo, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Ultrasound-Assisted Liposuction as a Treatment of Fat Necrosis After Deep Inferior Epigastric Perforator Flap Breast Reconstruction. Ann Plast Surg 2008; 60:614-7. [DOI: 10.1097/sap.0b013e3181453b8f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Nelson L, Stewart KJ. Plastic surgical options for HIV-associated lipodystrophy. J Plast Reconstr Aesthet Surg 2007; 61:359-65. [PMID: 18155655 DOI: 10.1016/j.bjps.2007.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 11/13/2007] [Indexed: 11/25/2022]
Abstract
With the reported prevalence of HIV-associated lipodystrophy approaching 80%, this patient group presents an increasing challenge to plastic surgeons. Based on a literature search conducted using OVID Medline, this review shall describe the various treatment options employed by plastic surgeons to deal with the problems of fat distribution in patients suffering from HIV-lipodystrophy, and examine the evidence for each treatment.
Collapse
Affiliation(s)
- L Nelson
- Plastic Surgery Department, St John's Hospital, Howden Road West, Livingston, West Lothian EH54 6PP, UK.
| | | |
Collapse
|
15
|
|
16
|
Abstract
Lipodystrophy and its two components lipo-accumulation and lipoatropy are very common among individuals with HIV infection on treatment, especially among those who started therapy in the late 1990s and early 2000s. This review discusses the current management of these complications of HIV and its treatment. For the purpose of clarity in this review, we have divided the interventions according to the predominant phenotype of the individual.
Collapse
Affiliation(s)
- Pablo Tebas
- University of Pennsylvania, AIDS Clinical Research Unit, 3451 Walnut Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
17
|
Hultman CS, McPhail LE, Donaldson JH, Wohl DA. Surgical management of HIV-associated lipodystrophy: role of ultrasonic-assisted liposuction and suction-assisted lipectomy in the treatment of lipohypertrophy. Ann Plast Surg 2007; 58:255-63. [PMID: 17471128 DOI: 10.1097/01.sap.0000248128.33465.83] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE HIV-associated lipodystrophy is a frequent consequence of highly active antiretroviral therapy and has been associated with several metabolic disorders (increased triglycerides, hypercholesterolemia, insulin resistance) as well as altered fat distribution, including lipohypertrophy (neck, trunk, breasts) and lipoatrophy (nasolabial fold, cheek, extremities). Medical treatment of fat redistribution is usually ineffective. We evaluated the efficacy and safety of the surgical management of HIV lipodystrophy. METHODS We performed a retrospective review of 12 consecutive patients (3 female, 9 male; mean age, 44.4 years; mean CD4+ cell count, 554/mm3; mean body mass index, 28.9 kg/m2; mean triglycerides, 421 mg/dL; no active opportunistic infections; mean duration of HIV infection, 11.4 years) who underwent surgical management of HIV lipodystrophy at a university hospital from 2001 to 2006. RESULTS Surgical intervention included a combination of ultrasonic-assisted liposuction (UAL) and suction-assisted lipectomy (SAL) of the anterior neck (7 patients), posterior neck (10 patients), and trunk (2 patients); direct excision of mastoid fat pads (1 patient); direct excision of thigh lipomata (1 patient); facelift/necklift (1 patient); browlift (1 patient); fat injections (1 patient); and blepharoplasty (2 patients). Mean lipoaspirate volume was 701 mL (range, 270-1400 mL). Complications and sequelae included seroma (1 patient), ecchymosis (1 patient), need for revision (2 patients), and recurrence (3 patients) but did not include nerve injury, fat necrosis, skin loss, or infection. Although all patients reported improvement in form and function, UAL/SAL of the anterior neck had limited efficacy in 3 of 7 patients. UAL/SAL of the cervicodorsal fat pad was initially successful in 10 of 10 patients, but 3 patients developed partial late (>1 year) recurrence, all associated with weight gain. Mean follow up was 30 months (range, 1-66 months). CONCLUSIONS Despite the potential for recurrence, surgical management of HIV-associated lipodystrophy is efficacious with minimal morbidity. UAL/SAL is particularly beneficial in reducing the cervicodorsal fat pad, whereas facelift and necklift may be necessary to adequately address anterior neck lipohypertrophy.
Collapse
Affiliation(s)
- C Scott Hultman
- Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, North Carolina 27599-7195, USA.
| | | | | | | |
Collapse
|
18
|
Reynolds NR, Neidig JL, Wu AW, Gifford AL, Holmes WC. Balancing disfigurement and fear of disease progression: Patient perceptions of HIV body fat redistribution. AIDS Care 2007; 18:663-73. [PMID: 16971273 DOI: 10.1080/09540120500287051] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study was conducted to identify and describe the perceived morphologic changes of body fat redistribution and related distress among persons taking combination antiretroviral therapy. Six focus group interviews were conducted in four different US cities with men and women (n = 58) who reported antiretroviral-related symptoms of body fat loss and/or gain. Interview data were audiotaped, transcribed verbatim and systematically analysed using inductive techniques. Physical discomfort and impairment and psychological and social distress were reported across sex, sexual orientation and geographic subgroups. While participants acknowledged that antiretroviral drugs were keeping them alive, there was tension between the desire for life-sustaining treatment and optimal quality of life. Some participants engaged in harmful heath behaviours in an attempt to control bodily changes (e.g. non-adherence to antiretroviral regimen). Participants feared that fat loss represented disease progression and worried that visible changes would lead to unintentional disclosure of their HIV status. Although a potential source of support, healthcare providers were commonly perceived as ignoring and, in so doing, discrediting patient distress. Participants recognised the limitations of current lipodystrophy treatment options, yet a cure for the syndrome seemed less important to them in the short term than simply being listened to and the powerful, but oblique sources of distress addressed.
Collapse
Affiliation(s)
- N R Reynolds
- Ohio State University College of Nursing and AIDS Clinical Trials Unit, Columbus, OH 43210, USA.
| | | | | | | | | |
Collapse
|
19
|
Negredo E, Higueras C, Adell X, Martinez JC, Martinez E, Puig J, Fumaz CR, Muñoz-Moreno JA, Perez-Alvarez N, Videla S, Estany C, Cinquegrana D, Gonzalez-Mestre V, Clotet B. Reconstructive treatment for antiretroviral-associated facial lipoatrophy: a prospective study comparing autologous fat and synthetic substances. AIDS Patient Care STDS 2006; 20:829-37. [PMID: 17192148 DOI: 10.1089/apc.2006.20.829] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lipodystrophy is one of the foremost concerns among the HIV-positive population, and is often associated with psychosocial disorders. We evaluated the clinical efficacy of facial infiltrations with autologous fat, polylactic acid, and polyacrylamide gel using clinical inspection and facial photographs (ordinal scale). Additionally, we assessed the safety of the infiltration techniques and determined changes in patient satisfaction, emotional status, and quality of life. Evaluations were made at 48- and 96-week follow-up visits. This paper presents the 48- week follow-up results. The current analysis includes 138 patients: 8, 25, and 105 in the fat, polylactic acid, and polyacrylamide gel groups, respectively. At baseline, almost 50% of the patients (67/138) presented grades 3 and 4 lipoatrophy, but at week 48 only 7.5% (7/93) remained in these advanced grades (no patients from the polyacrylamide group). A new round of infiltrations at week 48 was necessary in 35% (33/93) of patients (88%, 84%, and 8% in the fat, polylactic, and polyacrylamide groups, respectively). No serious adverse events were detected with any of the substances. Patient satisfaction and quality of life improved significantly in all three groups. Infiltrations with autologous fat, polylactic acid, or polyacrylamide gel appear to be an effective and safe alternative to repair facial lipoatrophy, at least up to 48 weeks, significantly improving patient quality of life. Similar results were observed for all degrees of severity and between genders. Polyacrylamide gel provided the longest lasting benefits.
Collapse
Affiliation(s)
- Eugenia Negredo
- HIV Unit, Fundació de la Lluita contra la Sida, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Baril JG, Junod P, LeBlanc R, Dion H, Therrien R, Laplante F, Falutz J, Côté P, Hébert MN, Lalonde R, Lapointe N, Lévesque D, Pinault L, Rouleau D, Tremblay C, Trottier B, Trottier S, Tsoukas C, Weiss K. HIV-associated lipodystrophy syndrome: A review of clinical aspects. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2005; 16:233-43. [PMID: 18159551 PMCID: PMC2095035 DOI: 10.1155/2005/303141] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 03/04/2005] [Indexed: 11/18/2022]
Abstract
Approximately two years after the introduction of highly active antiretroviral therapy for the treatment of HIV infection, body shape changes and metabolic abnormalities were increasingly observed. Initially, these were ascribed to protease inhibitors, but it is now clear that nucleoside reverse transcriptase inhibitors also contribute to lipodystrophy syndrome. The syndrome groups together clinical conditions describing changes in body fat distribution that include lipoatrophy, lipoaccumulation or both. However, there does not appear to be a direct link between lipoatrophy and lipoaccumulation that would support a single mechanism for the redistribution of body fat. Currently, there is no clear definition of lipodystrophy, which explains the difficulty in determining its prevalence and etiology. There are no current guidelines for the treatment of fat distribution abnormalities that occur in the absence of other metabolic complications. The present article reviews the current state of knowledge of the definition, symptoms, risk factors, pathogenesis, diagnosis and treatment of the morphological changes associated with lipodystrophy syndrome.
Collapse
Affiliation(s)
- Jean-Guy Baril
- Clinique médicale du Quartier Latin
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Service de lutte contre les infections transmissibles sexuellement par le sang, ministère de la Santé et des Services sociaux
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Patrice Junod
- Clinique médicale du Quartier Latin
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Roger LeBlanc
- Clinique Golberg, LeBlanc et Rosengren
- UHRESS, McGill University Health Centre, Royal Victoria Hospital
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Harold Dion
- Clinique médicale L'Actuel
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Rachel Therrien
- UHRESS, CHUM, Hôpital-Dieu de Montréal
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | | | - Julian Falutz
- UHRESS, McGill University Health Centre, Montreal General Hospital
| | - Pierre Côté
- Clinique médicale du Quartier Latin
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Marie-Nicole Hébert
- Service de lutte contre les infections transmissibles sexuellement par le sang, ministère de la Santé et des Services sociaux
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Richard Lalonde
- UHRESS, McGill University Health Centre, Royal Victoria Hospital
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Normand Lapointe
- UHRESS, Hôpital Sainte-Justine, Centre maternel et infantile sur le sida
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Dominic Lévesque
- Comité des personnes atteintes du VIH du Québec
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Lyse Pinault
- Coalition des organismes communautaires québécois de lutte contre le sida
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Danielle Rouleau
- UHRESS, CHUM, Hôpital Saint-Luc and Hôpital Notre-Dame
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Cécile Tremblay
- UHRESS, CHUM, Hôpital-Dieu de Montréal
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Benoît Trottier
- Unité hospitalière de recherche, d'enseignement et de soin sur le sida (UHRESS), Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc
- Clinique médicale L'Actuel
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Sylvie Trottier
- UHRESS, Centre hospitalier universitaire de Québec
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Chris Tsoukas
- UHRESS, McGill University Health Centre, Montreal General Hospital
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| | - Karl Weiss
- Association des médecins microbiologistes infectiologues du Québec, Hôpital Maisonneuve-Rosemont, Montréal, Québec
- Members of Le Comité consultatif sur la prise en charge Clinique des personnes vivant avec le VIH/Sida Ministère de la Santé et des services
sociaux du Québec
| |
Collapse
|
21
|
Hilton S, Mauss S, Ruzicka T, Bruch-Gerharz D. [HALS: HIV-Lipodystrophy associated syndrome]. Hautarzt 2005; 56:374-6. [PMID: 15750669 DOI: 10.1007/s00105-005-0925-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S Hilton
- Hautklinik, Heinrich-Heine-Universität, Düsseldorf
| | | | | | | |
Collapse
|