Lipoatrophy (Facial Wasting)

Facial wasting – lipoatrophy – is the loss of the fat under the skin. It makes the face look thin or gaunt. It makes wrinkles or folds in the skin more obvious. The condition can be caused by HIV infection itself and by the drugs that treat it. 

Symptoms

The loss of fat under the skin of the face makes people look older, tired or less well. The eyes, cheeks and temple appear to sink. Wrinkles or folds in the skin are more dramatic.

Wasting of the fat tissues of the face can cause person to:

• Lose self-confidence
• Be less willing to be socially active
• Lose interest in sex
• Have a lower sense of emotional well-being
• Feel less like sticking with treatment
• Be depressed 

Causes

Fat is important for a healthy body. Fat makes chemicals that send messages to the immune and digestive systems. To work, fat cells need a special type of fuel. This is made by tiny parts of cells called mitochondria. When the mitochondria are damaged or can’t reproduce, a fat cell stops working and dies. If the mitochchondria in organs such as the liver are damaged as well, there will be more facial wasting.

Nearly all anti-HIV drugs change the way fat is made, used and stored in the body. Some raise cholesterol and others make the body less sensitive to insulin. The drugs vary in how great an effect they cause.

Risk Factors

Three things have been linked to both mitochondrial damage and lipoatrophy:

• Using nucleoside analog anti-HIV drugs, especially stravudine and to a lesser degree zidovudine
• Being older than 40, and
• Having high triglycerides
• Low CD4 count when starting antiretroviral drugs (ARVs).

Diagnosis

It is important to make sure that the symptoms are of lipoatrophy and not wasting syndrome. Lipoatrophy is a loss of fat under the skin. Wasting syndrome is the loss of both fat and muscle. Wasting syndrome usually follows 30 days or more of either diarrhea or weakness and fever with the unintended loss of more than 10% of a person’s body weight. It is a sign that AIDS is progressing. 

Treatment

Currently, it isn’t possible to restore the fat. Sometimes changing anti-HIV drugs slows the fat loss. Stravudine often causes facial wasting. Sometimes it can be replaced by tenofovir, which fights AIDS without facial wasting.

Materials can be injected or implanted where the fat was lost. An example is Sculptra, which was approved by the FDA in 2004 to correct signs of facial fat loss from HIV infection. 

Treatment consists of three to six rounds of small injections. This is done every two weeks. The doctor usually numbs the area first. The shots of Sculptra usually involve some pain (not severe). There may also be tenderness, swelling and bruising where the injections were done.

Sculptra causes scar tissue and fat to collect where it has been injected. The results depend on the doctor’s skill and training. Sometimes small lumps occur after treatment. While these usually can’t be seen, they can be felt.