Rauso Raffaele, Curinga Giuseppe, Santillo Vincenzo, Corvo Giovanni, Tartaro Gianpaolo
Unit of Maxillo-Facial Surgery, Head and Neck Department, II University of Naples, Naples, Italy.
J Craniofac Surg. 2011 Sep;22(5):1684-8. doi: 10.1097/SCS.0b013e31822e5cf8.
Several treatments have been described for facial wasting rehabilitation in HIV-positive patients. In this article, we compare lipofilling and a nonabsorbable filler for facial wasting rehabilitation induced by antiretroviral therapy in HIV-positive patients.
This study was conducted as a clinical prospective study. Twenty-three HIV-positive patients affected by facial wasting were treated for facial rehabilitation, between January 2007 and December 2008, at the Head and Neck Department of the II University of Naples. They were divided into 2 groups; the first group was treated with lipofilling (group A), and the second one with the injection of a nonabsorbable filler, Aquamid reconstruction (Contura International A/S, Soeborg, Denmark) (group B).All the patients were HIV-positive, they had been receiving antiretroviral therapy for several years (1.8-6.7 years, 3.2 years on average) and showed clinical signs of facial lipoatrophy. Group A was composed of 14 patients (9 men, 5 women; mean age, 43.7 years), all presenting facial wasting and lipohypertrophied areas of the body. Group B was composed of 9 male patients, 7 presenting only facial wasting, and 2 presenting lipohypertrophied areas of the body (mean age, 44.8 years). Clinical efficacy was assessed independently by the investigator and the patient, 3 months, 6 months, and 1 year after baseline. The main assessment was made by the investigator using the Global Aesthetic Improvement Scale (GAIS) 1 year after baseline; secondary assessment using the GAIS was made by the investigator and the patient 6 months after baseline.
There were no major complications. No infections or other complications were observed. According to GAIS ratings, group A (lipofilling) obtained significantly higher ratings than did group B (nonabsorbable filler) after baseline (P < 0.05).
We can treat HIV-related lipodistrophy more extensively with lipofilling because, after harvesting the fat graft, other body contouring procedures also can be performed; there is a better aesthetic outcome in facial rehabilitation performed with lipofilling, probably due to the possibility to fill deeper than with nonabsorbable fillers.
已有多种治疗方法用于HIV阳性患者面部消瘦的康复治疗。在本文中，我们比较了脂肪填充和一种不可吸收填充剂用于HIV阳性患者抗逆转录病毒治疗引起的面部消瘦康复的效果。
本研究为临床前瞻性研究。2007年1月至2008年12月期间，那不勒斯第二大学头颈科对23例受面部消瘦影响的HIV阳性患者进行了面部康复治疗。他们被分为两组；第一组接受脂肪填充治疗（A组），第二组注射不可吸收填充剂Aquamid重建材料（丹麦索博格的Contura International A/S公司生产）（B组）。所有患者均为HIV阳性，他们接受抗逆转录病毒治疗已有数年（1.8 - 6.7年，平均3.2年），并表现出面部脂肪萎缩的临床症状。A组由14例患者组成（9例男性，5例女性；平均年龄43.7岁），均有面部消瘦和身体脂肪肥厚区域。B组由9例男性患者组成，7例仅表现为面部消瘦，2例有身体脂肪肥厚区域（平均年龄44.8岁）。在基线后的3个月、6个月和1年，由研究者和患者独立评估临床疗效。主要评估由研究者在基线后1年使用全球美学改善量表（GAIS）进行；次要评估由研究者和患者在基线后6个月使用GAIS进行。
未出现重大并发症。未观察到感染或其他并发症。根据GAIS评分，基线后A组（脂肪填充）的评分显著高于B组（不可吸收填充剂）（P < 0.05）。
我们可以用脂肪填充更广泛地治疗HIV相关脂肪营养不良，因为在采集脂肪移植物后，还可以进行其他身体塑形手术；脂肪填充进行面部康复的美学效果更好，可能是因为比不可吸收填充剂能填充得更深。
