International AIDS Society

Late Infections Affect 1 in 5 Using Bio-Alcamid for HIV Facial Atrophy

Author: Mark Mascolini

05 December 2012

Infectious complications arising 2 years or more after polyalkylimide (Bio-Alcamid) implantation for HIV-related facial fat atrophy affected 19% in a Toronto study group. Previous facial manipulation, including dental work, raised the risk of infectious complications.

Facial lipoatrophy can be a stigmatizing consequence of HIV infection and has been linked to treatment with stavudine (d4T) and some other nucleosides. Many physicians have used polyalkylimide implantation for facial lipoatrophy because it has some advantages over other facial fillers. After injection, the nonreabsorbable polymer induces tissue to form a fibrous capsule that can in theory be removed entirely years later. Polyalkylimide can also be injected in large volumes in a single session.

To assess rates and risk factors for infectious complications after polyalkylimide injection, researchers conducted this retrospective analysis of 267 HIV-positive people. Infectious complications developed in 56 of them (19%) a median of 32 months after injection (interquartile range 21 to 42).

Complication incidence was 0.07 per patient-year, meaning infection occurred in 7 of 100 treated people every year. Most people with complications required surgical drainage plus antibiotics.

The investigators found no association between infectious complications with polyalkylimide and HIV-induced immune suppression.

More severe facial lipoatrophy raised the chance of infectious complications, as did prior facial manipulation, including polyalkylimide touch-up treatments, cosmetic surgery, facial trauma, and dental work.

“Patients should be counseled regarding the risks and long-term adverse effects of Bio-Alcamid,” the researchers advise. They suggest that “antibiotic prophylaxis should be considered in patients with Bio-Alcamid prior to dental work or facial manipulation.”

Source: Jeya T. Nadarajah, Micaela Collins, Janet Raboud, DeSheng Su, Kavya Rao, Mona R. Loutfy, Sharon Walmsley. Infectious complications of Bio-Alcamid filler used for HIV-related facial lipoatrophy. Clinical Infectious Diseases. 2012; 55: 1568-1574.

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