FACIAL LIPOATROPHY LITERATURE REVIEW
By The Maple Leaf Medical Clinic, Toronto, Canada
www.mapleleafmedical.com
Maple Leaf Medical Clinic, located in Toronto Canada has published an informal review of the available literature on how lipodystrophy and facial lipoatrophy affect the quality of life of people living with HIV.
Despite considerable effort, there is still no universally accepted clinical definition of HIV-associated lipodystrophy, and its evaluation in clinical trials has been largely based on subjective assessments, made by both patients and physicians rather than on more objective measures; consequently, performing the necessary research that will generate a clear resolution to this problem, remains especially challenging.
Lipodystrophy is the ‘umbrella’ name used to describe body fat changes reported among people taking anti-HIV therapy. Fat loss from the face (facial wasting or lipoatrophy) is one of the components of lipodystrophy. Facial wasting usually occurs together with other changes in body shape as well as an increase in the amount of fat in the blood, however, it can be the only aspect of lipodystrophy that a person experiences.
The exact cause of facial wasting is not known: originally it was thought that protease inhibitors might be the cause, but most doctors now believe that it is caused by nucleoside analogues, particularly d4T and to a lesser extent AZT.
Multiple studies have shown that facial lipoatrophy can erode self-esteem, cause psychological distress, and lead to depression: basically, it can marginalize those affected as well as impact a person’s ability to work and remain financially independent. Treatments that can correct the appearance of those affected are being tested around the world.
The positive effects of treatments and procedures that can repair the effects of facial wasting, are far reaching. Studies assessing psychological parameters of HIV-infected patients with facial wasting (who are undergoing corrective treatment) have shown that after treatment there is an improvement in anxiety and depression scores and in health perception—both mental and transitory health— and emotional status. In other words, an improved appearance, not unpredictably, makes people feel better.
Clinicians should consider available treatments and procedures that correct the appearance of lipoatrophy for patients who feel adversely affected by the condition.
Avoiding lipoatrophy altogether would be preferable to treating it, however our understanding of the pathology (the process of disease) of lipoatrophy is incomplete. Until we know more, there are new procedures that are available to cosmetically correct the facial abnormalities produced by lipoatrophy — using products known as fillers. These fillers can improve both the physical disfigurement and psychological damages caused by lipoatrophy; and until effective prevention or reversal treatments are available, they are currently the most promising treatment method.
For a detailed copy of the literature review, please click here
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