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

• Main Author: Nelson, Lisa
• Published: University of Edinburgh 2012
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.735475

Introduction: HIV-associated facial lipoatrophy is a stigmatizing condition associated with significant psychological morbidity. The condition may be treated with soft tissue fillers, although quantification of objective and patient-reported outcomes is lacking. The primary aim of this study was to evaluate change in facial volume and psychological morbidity following treatment for HIV lipodystrophy with autologous fat transfer, Newfill and Bio- alcamid. An additional aim of the study was to compare psychological characteristics between HIV seropositive patients with lipodystrophy (HIV LD) and without lipodystrophy (HIV non-LD) and HIV seronegative men who have sex with men (MSM). Methods: HIV LD patients were treated with autologous fat, Newfill or Bio-alcamid based on a clinical assessment in a prospective, observational study. The Colemnan technique of fat transfer was utilised. Newfill injections were carried out at monthly intervals using 1 vial per cheek. Bio-alcamid was injected subcutaneously under aseptic technique to achieve the desired cheek augmentation. 3-D images were obtained pre-operatively then at 2, 6 and 12 months post-operatively using the DI3D system. Volume changes in treated areas were measured using DI3D software. The DAS-24 and HADS were used to assess psychological morbidity at similar time intervals. An additional case-control study was conducted to measure psychological morbidity in HIV LD, HIV non-LD and MSM groups utilising the Derriford Appearance Scale (DAS-24) and Hospital Anxiety and Depression Scale (HADS). Data was analyzed using appropriate statistical tests. Results ANOVA tests demonstrated significantly higher DAS-24 scores in the HIV-LD group compared to the HIV non-LD and MSM groups. No difference in HADS-A scores was seen between groups. 48 patients with HIV LD were treated: 16 patients had Bio-alcamid augmentation, 20 patients received Newfill injections and 12 patients underwent fat transfer. The mean injected volume of Bio-alcamid was 25.5cc The Wilcoxin test demonstrated no significant difference in mean volume change relative to zero at 2, 6 and 12 months. The mean injected volume of fat was 20.1cc, which did not differ from the measured volumes at 2 months (1)= 0.15). There was a mean reduction in measured volume of 7.3cc at 6 months and 9cc at 12 months (p < 0.001). For Newfill, the mean volume change compared to baseline was 8.7cc at 2months, increasing to 12.6cc at 6 months and 12.3cc at 12 months. ANOVA tests demonstrated no difference in psychological outcomes between groups. There was a significant improvement in DAS-24 scores compared too baseline for all 3 groups throughout follow-up. For Bio-alcamid, a significant improvement in HADS-A and HADS-D scores were seen at 2 months but mean scores increased at 6 and 12 months. In the fat group, some improvement in HADS-A and HADS-D scores were seen at follow-up, although values only reached significance at 6 months. In the Newfill group, small improvements in both HADS-A and HADS -D were demonstrated in the post-treatment scores, although these did not reach significance. No correlation between change in facial volume and psychological measures was demonstrated. Conclusions: The case control study demonstrated that patients with HIV lipodystrophy have greater distress relating to body image and depression compared to HIV-seropositive patients without lipodstrophy and HIV-seronegative MSM control groups. The prospective study of the HIV LD treatment cohort demonstrated a change in 3-D measured facial volume for all 3 groups. Bio-alcamid produced the greatest, permanent volume change but was associated with the most complications. Newfill was associated with a moderate, delayed volume augmentation but was insufficient for some patients with severe lipoatrophy. Volume enhancement with autologous fat was good immediately post-operatively but variable degrees of fat resorption occurred. Treatment was associated with improved body image perception. However, initial improvements in anxiety and depression symptoms were not maintained in the long term.