martes, 10 de enero de 2012

TREATMENT OF HIV-associated lipodystrophy syndrome

TREATMENT OF HIV-associated lipodystrophy syndrome

Lipodystrophy is a syndrome that encompasses several symptoms. This is a series of adverse effects related to the way our body processes fats and sugars, which have been associated, above all, taking antiretroviral therapy.
Symptoms of lipodystrophy

Colloquially, when we talk we associated lipodystrophy abnormal redistribution of body fat, which can be both loss and fat accumulation.
The subcutaneous fat loss called lipoatrophy.

It is usually more frequent and visible in the legs, arms, buttocks and especially in the face. It can be mild, almost imperceptible, or important. Having Lipoatrophy in the buttocks can become difficult to sit still for a long time for the pain of the absence of fat.
Lipoatrophy in the face is one of the effects today, continues to cause more stigma and discrimination.
The abnormal accumulation of fat called lipohypertrophy, but usually we refer to as hypertrophy.
The fat that grows inside the abdomen called visceral or intra-abdominal fat, because it takes place between organs. You can get to push them so that the person ends up with an important sense of swelling, which can prevent or even sit comfortably breathe or eat properly.
Fat can also accumulate in the breasts of both men and women. The concentration of large amounts in the neck and upper back (dorsocervical area) is called a buffalo hump, colloquially, and can also be disabling.
The definition of lipodystrophy, also includes other effects on fats and sugars that are not visible to the naked eye, but the results of a blood test. So, they are called laboratory abnormalities. These metabolic changes are:
Increases in blood fats or lipids (cholesterol and triglycerides).
Increases in blood sugar (glucose) and development of insulin resistance that can sometimes lead to the emergence of a type of diabetes called type 2 mellitus or, in the general population is associated with obesity.

What are the causes

Today, still know all the factors that contribute to the onset of lipodystrophy, but it is known that the use of certain antiretroviral drugs favors very important that development.
Although doctors previously thought that the long-term use of protease inhibitors was linked to lipodystrophy, recent studies indicate that reverse transcriptase inhibitors, nonnucleoside could play a significant role.
Increases in cholesterol and triglycerides as well as increases in blood glucose and insulin resistance have been associated with antiretroviral therapy in general, although there are some drugs that appear to be more involved than others.
Other factors that have been associated with the development of lipodystrophy are the person's age, duration of HIV infection have begun treatment with very low CD4 counts and genetic factors.
Who is affected

Both men and women and children from different ethnic backgrounds have developed lipodystrophy, but each person can manifest itself differently. According to the Panel Study of Metabolic Disorders, lipodystrophy affect approximately 30% of people in anti-HIV treatment.
It is difficult to predict and there is no test that can help to know who is going to experience what symptoms. It is therefore important to prevent or detect its appearance soon. Today, there are many things to do.
What can be done

Be prevented, especially lipoatrophy, opting, less toxic treatments, if possible and always evaluating your options with your doctor therapeutic.
Be reversed in part, and above all stop, if detected early. There are techniques for measuring body fat losses or gains can see very tempranas.Este phased Bioimpedance method is called and is performed with equipment that measures the different body components (total water, fat mass and lean mass).
The results of blood tests we do are often indicators that account for changes in lipid and glucose before they become a problem.
You can repair the loss of fat in the face, and, in some cases, the accumulations. These treatments consist of definitive facial fillers fillers such as Aquamid, calcium hydroxylapatite for facial lipodystrophy.

What are facial fillers?

In general, facial fillers are injectable products that can be used to fill depressions in the face, such as those caused by lipoatrophy. Both temporary facial fillers and permanent available. The temporary usually lasting from three to twelve months (sometimes a little more) and usually require touch-ups to maintain their results. Permanent facial fillers provide benefits that last long term, but generally can not be removed in case the results are not desired.

Or non-surgical liposuction Ultracavitation indicated hump, neck and abdomen. (Click on the link

Types of facial fillersTemporary Fillings Radiesse: This product contains a synthetic version of calcium hydroxylapatite, a substance found in bones and teeth. Radiesse was approved for the correction of lipoatrophy associated with HIV in December 2006. The company that makes Radiesse, BioForm Medical, a program designed for the patient assistance (PAP) to provide the fill at a reduced cost to those HIV-positive patients who meet the eligibility requirements.

Sculptra: This filling acid-containing poly-L-lactic acid, a synthetic product that has long used in reconstructive surgery. Sculptra was approved for the correction of lipoatrophy associated with HIV in August 2004. Sculptra's production company, Dennis Labotatories, has designed a program for the patient assistance (PAP) to provide the fill at a reduced cost to those HIV-positive patients who meet the eligibility requirements.

Autologous fat transplantation: This procedure involves removing fat from one part of the body (buttocks, hips, inner thigh or abdomen), cleaning, filtration and injection into other body part, such as the face . It is considered one of the most natural facial fillers and also the remaining fat removed may be stored in case future touch-ups needed. However, it may be difficult to extract the fat from other parts of the body, especially in HIV positive people with lipoatrophy advanced and lack of subcutaneous fat. Sometimes the injected fat may become abnormally large mass (hypertrophy). This is seen most commonly in patients who have been removed fat from a "buffalo hump" that exists to fill facial depressions. Autologous fat transplants do not require FDA approval, but should be performed by a plastic surgeon with experience in the use of this methodology in the correction of lipoatrophy.
Collagen (Bovine: Zyderm and Zyblast; human: CosmoDerm and CosmoPlast): Collagen has been used in the United States for cosmetic purposes for over 25 years, most commonly for filling facial wrinkles. Because the FDA has approved for this purpose long ago, was one of the first products evaluated and used in HIV-positive people with facial lipoatrophy. Bovine collagen is derived from calf skin. The human collagen derived from human tissue growth in test tubes. If bovine collagen is used, it is necessary to analyze allergen before injecting the product in the face. While none of these types of collagen is specifically approved for HIV-associated lipoatrophy, both widely available and many cosmetic surgeons are experienced in their use ..

Hyaluronic acid (Restylane, Perlane): Hyaluronic acid is naturally found in human connective tissue. These three trademarks are synthetic versions of hyaluronic acid and have been designed so that they are not rapidly metabolized by the body. They are not specifically approved for the correction of lipoatrophy associated with HIV, but are widely available.

Stuffed permanents 

Polimetimetacrilato (PMMA, Artefill, Precise, Metacrill): PMMA is best known for its use in the production of non-flexible contact lenses and Plexiglas. These products contain small particles (microspheres) of PMMA. ArteFill also contains bovine collagen, Precise and Metacrill not contain it. After being injected, the body produces collagen surrounding the PMMA microspheres. PMMA molecules and the surrounding collagen persist indefinitely. The FDA approved ArteFill for the correction of wrinkles, facial lines and furrows (not HIV). Precise and Metacrill have not yet been evaluated by the FDA. Most HIV-positive people who used these products were in Mexico or Brazil.
Polyalkylimide (Bio-Alcamid): Bio-Alcamides a synthetic product that can be injected in large volumes. There is very little experience in clinical trials and the use of Bio-Alcamid in the United States. However, it has been used in Europe, Canada and Mexico cosmetic and reconstructive purposes. There have been reports of infections in the cavity of the tissue containing Bio-Alcamid, even years later, has also been reported that Bio-Alcamid can migrate down into the jaws. Removal of Bio-Alcamid is possible if necessary.
Polyacrylamide hydrogel (Aquamid): Aquamid is a synthetic molecule that binds to water and has been used mainly for filling areas of small to moderate. Is said to be permanent, although longer studies are only 11 years' duration. Aquamid is not approved in the United States, but has been used mainly in Europe. Studies in people with HIV-related lipoatrophy have shown good results in Italy and Spain. The product can be removed immediately after application if necessary.
Silicone oil (Silikon 1000, VitreSil 1000): The silicone comes in solid and liquid formulations. The solid silicone is rarely used for facial lipoatrophy. The silicone oil (silicone oil) is more commonly used, but its safety and efficacy for cosmetic purposes remains controversial. For now, the silicone oil is only approved for ocular repair, and research continues on facial filler. Once injected can not be removed. The cost varies greatly depending on the amount of silicone oil use and application fees related to the injections.

Politetrafluorentileno implants expanded (ePTFE) (Gore-Tex, Gore SAM, SoftForm): These solid implants require minor surgery through a small incision under local anesthesia. Have been used for many years to help restore deep facial defects could be useful for HIV-associated lipoatrophy, as fillers large sunken areas. Some experts believe that ePTFE should be used in combination with other fillers, particularly those that generate collagen production. There is a risk of postoperative complications, including infection and scarring, and also the procedure could be expensive.

For more information please contact us at:

Antiaging and Aesthetic Medicine
Palermo Soho, Buenos Aires - Argentina
Phone: +(5411) 2064 2639 and +(549) 15 6180 6736 (by appointment)