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Intradermal polylactic acid (Newfill®) for treatment of severe HIV — associated facial lipoatrophy
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FIS 2001 Abstracts
POSTER PRESENTATION ABSTRACTS PO1
PO2
AN OUTBREAK OF HEPATITIS A IN INJECTION DRUG USERS. A. Cadwgan’, R.Laing’, P.Molyneaux’
RETROSPECTIVE A STUDY ON COMPLICATIONS OF HAART IN NORTH EAST ENGLAND. Mustafa M, Price DA, Schmid M, Snow M,Ong ELC, Dept of Infection & Tropical Medicine, Newcastle General Hospital, Newcastle upon Tyne. Objectives: To analyze the complications of HAART and their impact on switching of the HAART regimen Methods: HIV patients who were on HAART between January 1997 and June 2001 for at least 6 months were evaluated.The complications with particular attention to adverse reactions, virologic failure and adherence reviewed. The impact on changing HAART regimen were also analyzed. Results: 120 patients were included where 86% were men, mean age 37.3 years, 48.3% homosexual, 32.5% heterosexual and 5% IV drug user. Mean CD4 and RNA viral load (VL) prior to HAART were 152/mm3 and 207,958 copies/ml. Poor adherence was seen in 19.2% and 67.5% of patients experienced adverse reactions that led to the switch. Long term toxicities were diabetes (6.6%), lipodystrophy (15.0%) and hypercholestrolemia (57.5%). Only 37(30.8%) of patients did not require alteration to their therapy with mean duration of therapy 33.06 months. 74.6% of patients had VL <400copies/ml and 64.4% had VL suppressed to ~50 copies/ml while on latest regimen. Conclusion: Although therapy failure secondary to virologic resistant is important, adverse drug reactions and poor adherence to prescribed drugs are the major complications and obstacle to current complex regimen.
D.Robson’, M.Beadsworth’, A. Mackenzie’, G. Douglas’ Infection Unit’, Department of Virology*, Aberdeen Royal Infirmary, Scotland Since October 2000 75 cases of Hepatitis A have been diagnosed in the Aberdeen area, all linked to at least one other case. Clinical, biochemical and virological data on all of the cases to 31/8/01 have been reviewed. Of the first 75 cases 59 were male and 16 female. Median age was 24 years. 17 patients (23%) were asymptomatic. 61 (81%) were current or previous injection drug users (IDUs), 34 cases were seen in the Infection Unit and 25 (33 %) were admitted to hospital. Mean peak aspartate aminotransferase was 662 IU/L (range 27-3418). Five patients had a prolonged prothrombin time, none developed fulminant hepatic failure. 29 patients of 59 tested (49%) were HCV Ab positive. Only six (21%) of these 29 patients were PCR positive for HCV. The source of the outbreak is unknown but may have been heroin contaminated with faecal material. Spread in this epidemic is thought to be faecal-oral due to poor hygiene. Unlike previous reports of HAV in IDUs we have not seen any severe illness. This may be due to the smaller than expected number with chronic viral hepatitis infection. The low level of HCV-PCR positives amongst those with HCV antibody is not readily explained. It may be that HAV infection prevents HCV replication.
PO3
*
DEVELOPMENT OF A NOVEL QUALITY OF LIFE QUESTIONNAIRE TO ASSESS THE IMPACT OF POLYLACTIC ACID TREATMENT FOR HIVASSOCIATED FACIAL LIPOATROPHY Shiner A M, Day J N, Wilkins E G L. Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, UK. HIV-associated facial lipoatrophy (FLA) adversely affects the psychosocial functioning of those with the condition. Facial injections with intradertnal polylactic acid (NEWFILLB) represents a new therapeutic approach. Anecdotal reports suggest that this treatment improves quality of life. This has not been objectively assessed. SUBJECTS: 7 untreated patients and 8 patients who had completed 3 sets of NEWFILLO injections. METHODS: A novel FLA specific questionnaire was designed and administered alongside a previously validated HIV-specific measure (the HIV-AIDS Targeted Quality of Life instrument (HAT-QoL)). Scores from the novel questionnaire were compared with the HATQoL. RESULTS: The HATQoL found no difference in quality of life between the 2 groups but the novel questionnaire found significant differences in some domains. This was supported by written feedback from the subjects. CONCLUSIONS: The novel questionnaire may be more sensitive in detecting quality of life changes in this patient group, but requires further validation.
PO4
*
INTRADERMAL POLYLACTIC ACID (NEWFILL@) FOR TREATMENT OF SEVERE HIV -ASSOCIATED FAClAL LIPOATROPHY. J N Day, A Raabe, A M Shiner, E G L Wilkins, Department of Infectious Diseases and Tropical Medicine, Monsall Unit, North Manchester General Hospital, UK. HIV associated facial lipoatrophy (FLA) is an increasing problem in patients receiving antiretroviral therapy, and has marked effects on self - esteem and social functioning. Patient concerns about FLA may lead to reduced adherence and limit treatment choices with important impacts on the subjects overall health. We assessed the effect of NEWFILLO on FLA through facial photography and ultrasound scanning. METHODS: 16 patients were treated with NEWFILLB injections at 2 to 4 week intervals for a minimum of 3 treatments. 8 patients had facial ultrasonography prior to treatment. Photography was performed prior to treatment and at 3 and 6 months. Improvement in appearance was assessed by review of photographs by an independent observer unaware of temporal relationship between treatment and photograph. RESULTS: No patient had greater than 2mm of subcutaneous adipose tissue prior to treatment. All subjects had improvement in appearance and skin thickness. Sideeffects included bruising and 1 episode of infection. CONCLUSION: NEWFILLB improved appearance at 3 months in FLA and was well tolerated.
FIS 2001 Abstracts
POSTER PRESENTATION ABSTRACTS PO1
PO2
AN OUTBREAK OF HEPATITIS A IN INJECTION DRUG USERS. A. Cadwgan’, R.Laing’, P.Molyneaux’
RETROSPECTIVE A STUDY ON COMPLICATIONS OF HAART IN NORTH EAST ENGLAND. Mustafa M, Price DA, Schmid M, Snow M,Ong ELC, Dept of Infection & Tropical Medicine, Newcastle General Hospital, Newcastle upon Tyne. Objectives: To analyze the complications of HAART and their impact on switching of the HAART regimen Methods: HIV patients who were on HAART between January 1997 and June 2001 for at least 6 months were evaluated.The complications with particular attention to adverse reactions, virologic failure and adherence reviewed. The impact on changing HAART regimen were also analyzed. Results: 120 patients were included where 86% were men, mean age 37.3 years, 48.3% homosexual, 32.5% heterosexual and 5% IV drug user. Mean CD4 and RNA viral load (VL) prior to HAART were 152/mm3 and 207,958 copies/ml. Poor adherence was seen in 19.2% and 67.5% of patients experienced adverse reactions that led to the switch. Long term toxicities were diabetes (6.6%), lipodystrophy (15.0%) and hypercholestrolemia (57.5%). Only 37(30.8%) of patients did not require alteration to their therapy with mean duration of therapy 33.06 months. 74.6% of patients had VL <400copies/ml and 64.4% had VL suppressed to ~50 copies/ml while on latest regimen. Conclusion: Although therapy failure secondary to virologic resistant is important, adverse drug reactions and poor adherence to prescribed drugs are the major complications and obstacle to current complex regimen.
D.Robson’, M.Beadsworth’, A. Mackenzie’, G. Douglas’ Infection Unit’, Department of Virology*, Aberdeen Royal Infirmary, Scotland Since October 2000 75 cases of Hepatitis A have been diagnosed in the Aberdeen area, all linked to at least one other case. Clinical, biochemical and virological data on all of the cases to 31/8/01 have been reviewed. Of the first 75 cases 59 were male and 16 female. Median age was 24 years. 17 patients (23%) were asymptomatic. 61 (81%) were current or previous injection drug users (IDUs), 34 cases were seen in the Infection Unit and 25 (33 %) were admitted to hospital. Mean peak aspartate aminotransferase was 662 IU/L (range 27-3418). Five patients had a prolonged prothrombin time, none developed fulminant hepatic failure. 29 patients of 59 tested (49%) were HCV Ab positive. Only six (21%) of these 29 patients were PCR positive for HCV. The source of the outbreak is unknown but may have been heroin contaminated with faecal material. Spread in this epidemic is thought to be faecal-oral due to poor hygiene. Unlike previous reports of HAV in IDUs we have not seen any severe illness. This may be due to the smaller than expected number with chronic viral hepatitis infection. The low level of HCV-PCR positives amongst those with HCV antibody is not readily explained. It may be that HAV infection prevents HCV replication.
PO3
*
DEVELOPMENT OF A NOVEL QUALITY OF LIFE QUESTIONNAIRE TO ASSESS THE IMPACT OF POLYLACTIC ACID TREATMENT FOR HIVASSOCIATED FACIAL LIPOATROPHY Shiner A M, Day J N, Wilkins E G L. Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester, UK. HIV-associated facial lipoatrophy (FLA) adversely affects the psychosocial functioning of those with the condition. Facial injections with intradertnal polylactic acid (NEWFILLB) represents a new therapeutic approach. Anecdotal reports suggest that this treatment improves quality of life. This has not been objectively assessed. SUBJECTS: 7 untreated patients and 8 patients who had completed 3 sets of NEWFILLO injections. METHODS: A novel FLA specific questionnaire was designed and administered alongside a previously validated HIV-specific measure (the HIV-AIDS Targeted Quality of Life instrument (HAT-QoL)). Scores from the novel questionnaire were compared with the HATQoL. RESULTS: The HATQoL found no difference in quality of life between the 2 groups but the novel questionnaire found significant differences in some domains. This was supported by written feedback from the subjects. CONCLUSIONS: The novel questionnaire may be more sensitive in detecting quality of life changes in this patient group, but requires further validation.
PO4
*
INTRADERMAL POLYLACTIC ACID (NEWFILL@) FOR TREATMENT OF SEVERE HIV -ASSOCIATED FAClAL LIPOATROPHY. J N Day, A Raabe, A M Shiner, E G L Wilkins, Department of Infectious Diseases and Tropical Medicine, Monsall Unit, North Manchester General Hospital, UK. HIV associated facial lipoatrophy (FLA) is an increasing problem in patients receiving antiretroviral therapy, and has marked effects on self - esteem and social functioning. Patient concerns about FLA may lead to reduced adherence and limit treatment choices with important impacts on the subjects overall health. We assessed the effect of NEWFILLO on FLA through facial photography and ultrasound scanning. METHODS: 16 patients were treated with NEWFILLB injections at 2 to 4 week intervals for a minimum of 3 treatments. 8 patients had facial ultrasonography prior to treatment. Photography was performed prior to treatment and at 3 and 6 months. Improvement in appearance was assessed by review of photographs by an independent observer unaware of temporal relationship between treatment and photograph. RESULTS: No patient had greater than 2mm of subcutaneous adipose tissue prior to treatment. All subjects had improvement in appearance and skin thickness. Sideeffects included bruising and 1 episode of infection. CONCLUSION: NEWFILLB improved appearance at 3 months in FLA and was well tolerated.