Strand Anders, Wolters Marianne
Aesthet Surg J. 2006 Jan-Feb;26(1S):S35-40. doi: 10.1016/j.asj.2005.08.002.
HIV-associated lipodystrophy syndrome affects approximately 50% of HIV-positive patients, particularly those receiving antiretroviral therapy based on nucleoside reverse transcriptase inhibitors and protease inhibitors. Growing evidence suggests that certain antiretroviral drugs may precipitate or exacerbate lipoatrophy and associated metabolic abnormalities, and this is an important consideration when selecting appropriate treatment regimens. However, because of problems of cross-resistance among antiretroviral drug classes and other treatment-related toxicities, it is likely that, at some stage, the HIV-infected patient will have to take drugs that confer a risk of development of lipodystrophy syndrome. Combination therapy for HIV, known as highly active antiretroviral therapy (HAART), has dramatically altered the prognosis for the HIV-infected individual. With optimal use of HAART, which includes regular monitoring of viral load, viral resistance, and compliance with medication, HIV infection has changed from being a fatal disease to a lifelong infection. However, HAART-related lipodystrophy syndrome, and especially facial lipoatrophy, is of great concern for patients and physicians involved in HIV care. For the patient, facial lipoatrophy is a major stigma that affects self-esteem and social interaction, and in some cases, it is a cause of noncompliance with HAART. Accordingly, many treatment-experienced HIV patients are requesting, and being treated with, various dermal fillers for cosmetic correction of facial lipoatrophy. Prior to the introduction of HAART, when life expectancy for the HIV-infected individual was severely limited, permanent fillers were widely used for this purpose. Because these products remain in situ indefinitely and the facial soft tissues change over time, the permanent fillers are no longer a satisfactory treatment option. Now that HIV infection has been transformed into a chronic but not necessarily life-threatening disease, there is an urgent need for a safe, biodegradable, and biocompatible alternative dermal filler for treating HIV-associated facial lipoatrophy.
与人类免疫缺陷病毒（HIV）相关的脂肪代谢障碍综合征影响着约50%的HIV阳性患者，尤其是那些接受基于核苷类逆转录酶抑制剂和蛋白酶抑制剂的抗逆转录病毒治疗的患者。越来越多的证据表明，某些抗逆转录病毒药物可能会引发或加剧脂肪萎缩及相关代谢异常，这在选择合适的治疗方案时是一个重要的考虑因素。然而，由于抗逆转录病毒药物类别之间存在交叉耐药问题以及其他与治疗相关的毒性，HIV感染患者很可能在某个阶段不得不服用有引发脂肪代谢障碍综合征风险的药物。针对HIV的联合治疗，即高效抗逆转录病毒治疗（HAART），极大地改变了HIV感染者的预后。通过对HAART的优化使用，包括定期监测病毒载量、病毒耐药性以及服药依从性，HIV感染已从一种致命疾病转变为一种终身感染性疾病。然而，与HAART相关的脂肪代谢障碍综合征，尤其是面部脂肪萎缩，是参与HIV治疗的患者和医生极为关注的问题。对患者而言，面部脂肪萎缩是一个严重影响自尊和社交互动的耻辱标记，在某些情况下，它还是患者不依从HAART治疗的一个原因。因此，许多有治疗经验的HIV患者要求使用各种真皮填充剂对面部脂肪萎缩进行美容矫正，并正在接受此类治疗。在HAART引入之前，当HIV感染者的预期寿命受到严重限制时，永久性填充剂曾被广泛用于此目的。由于这些产品会无限期地留存于原位，而面部软组织会随时间变化，永久性填充剂已不再是一个令人满意的治疗选择。既然HIV感染已转变为一种慢性但不一定危及生命的疾病，那么迫切需要一种安全、可生物降解且生物相容性良好的替代真皮填充剂来治疗与HIV相关的面部脂肪萎缩。
