Current status and perspectives in the treatment of facial lipoatrophy in HIV-positive patients in 2024

Facial lipoatrophy, a sign of normal aging, also occurs due to lipodystrophy from metabolic disorders affecting lipogenesis. It can be hereditary or acquired, localized or generalized. In HIV patients, prolonged antiretroviral therapy (ART) is a major cause, affecting around 55% of patients with 47% experiencing facial lipoatrophy. The exact changes in adipose tissue in HIV patients are unclear. Atrophic areas show immature adipose tissue, inflammation, and increased apoptosis. NRTIs cause mitochondrial toxicity, leading to energy depletion and adipocyte apoptosis. PIs disrupt protein expression related to adipocyte metabolism, causing apoptosis and metabolic issues. Lipoatrophy leads to fat loss in the cheeks, temporal, and sub-zygomatic regions, resulting in a cachectic appearance. Despite severe lipoatrophy, Bichat's fat pad often remains unaffected. Various scales assess lipodystrophy severity: James Scale, Fontdevilla Scale, Funk Scale, Facial Lipoatrophy Scale. Facial lipoatrophy significantly impacts patients' quality of life, leading to poor body image and depression. The MOS-HIV and ABCD questionnaires assess the impact on quality of life. Several therapeutic options are described: antiretroviral switch, growth hormone, glitazones, excision and suturing, human cadaveric dermis and Fascia, dermafat, fillers, lipofilling, implants and flaps.