Management options for facial lipoatrophy

Lipoatrophy of the face, limbs, buttocks, and other subcutaneous tissue is increasingly recognized in HIV-infected patients. Although the pathogenesis of lipoatrophy and its association with metabolic abnormalities are becoming better understood with intense research efforts, there are very few treatment options, and the appearance of facial lipoatrophy can be devastating to patients. Treatment strategies include antiretroviral substitution, medications, and dermatologic and surgical interventions. Switching the HAART regimen produces only a modest effect. There are conflicting and generally disappointing data on the benefit of medications such as rosiglitazone. Surgical and dermatologic procedures are available for treatment of facial lipoatrophy, and several facial fillers have gained popularity as a means to restore the facial contour. Most are expensive, require multiple visits, and can produce scars. Temporary fillers require ongoing reapplication, and permanent fillers may sag if lipoatrophy progresses. All require a pure compound and expert technique and can be prohibitively expensive because these procedures are not generally covered by insurance. Prevention and early recognition of lipoatrophy and proper selection or early modification of antiretroviral treatment remain the best options.