Treatment of HIV lipoatrophy and lipoatrophy of aging with poly-L-lactic acid: A prospective 3-year follow-up study

• Published in: Journal of the American Academy of Dermatology 2008-12, Vol.59 (6), p.923-933
• Main Authors: Levy, Ross M., MD, Redbord, Kelley Pagliai, MD, Hanke, C. William, MD, MPH
• Format: Article
• Language: English
• Subjects: Aged; Aging - pathology; Biological and medical sciences; Cellulose - adverse effects; Cellulose - therapeutic use; Cohort Studies; Dermatology; Female; Follow-Up Studies; HIV-Associated Lipodystrophy Syndrome - drug therapy; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Lactic Acid - adverse effects; Lactic Acid - therapeutic use; Lipodystrophy - drug therapy; Male; Mannitol - adverse effects; Mannitol - therapeutic use; Medical sciences; Middle Aged; Patient Satisfaction; Polyesters; Polymers - adverse effects; Polymers - therapeutic use; Prospective Studies; Skin involvement in other diseases. Miscellaneous. General aspects; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2008.07.027

Background Poly-L-lactic acid (PLLA), marketed as Sculptra (Dermik Laboratories, Bridgewater, NJ), is used for subcutaneous volume restoration. Durability studies are ongoing and longevity data are not yet available. Objective We sought to evaluate the long-term efficacy and safety of PLLA during 3 years of follow-up. Methods We conducted a prospective cohort study. Primary outcome measures were facial lipoatrophy score, complications, and patient satisfaction. Results In all, 65 patients were initially treated with PLLA; 27 patients were HIV positive and 38 were HIV negative. Of those patients, 12 were lost to follow-up. Both HIV-positive and HIV-negative patients demonstrated statistically significant improvement in facial lipoatrophy score at the end of 3 years; HIV-positive patients had a net improvement of 2.50 points ( P < .01) and HIV-negative patients had a net improvement of 1.11 points ( P < .01) on the Facial Lipoatrophy Grading Scale. Subgroup analyses revealed no statistically significant difference in facial lipoatrophy score between years 2 and 3 among patients who did not receive treatment during the third year. Complications were rare and included subcutaneous papule formation, which improved spontaneously and partially responded to subcision in one patient. Limitations Sample size was limited in this study. In addition, 12 of 65 patients (18%) were lost to follow-up between years 2 and 3. Conclusions PLLA provides volumetric correction of HIV lipoatrophy and lipoatrophy of aging. Results appear to be long lasting and correction can be maintained for up to 3 years with additional treatment sessions. In a subset of patients, correction is maintained for at least 1 year after their last treatment session. Patient satisfaction with PLLA is high.