While HIV is now a manageable condition, some older treatments were linked to changes in facial appearance. This condition, known as facial lipodystrophy, involves alterations in how the body stores fat and was a frequent side effect of earlier antiretroviral therapies. With newer medications, these facial changes are significantly less common, but understanding the condition remains relevant for those affected previously.
Defining HIV-Associated Facial Lipodystrophy
HIV-associated facial lipodystrophy primarily manifests as fat loss (lipoatrophy), resulting in a distinct change in facial structure. The most prominent signs include the development of sunken cheeks as the buccal fat pads diminish. This can lead to a gaunt and prematurely aged appearance.
Another common characteristic is the hollowing of the temples, where the temporal fat pads waste away. This change can alter the overall shape of the upper face. In some individuals, the fat around the eye sockets also decreases, causing the eyes to seem recessed. These changes are symmetrical, affecting both sides of the face equally.
While fat loss is the most defining feature of facial lipodystrophy, a less common manifestation is fat accumulation, known as lipohypertrophy. In the facial area, this might present as a “double chin” or increased fullness in the lower face. It is possible for an individual to experience both fat loss and fat gain simultaneously.
The Causes of Facial Changes
The development of facial lipodystrophy is not caused by the HIV infection itself but is strongly linked to certain older antiretroviral drugs. Research has identified specific classes of these medications as the primary drivers. The most significant association is with nucleoside reverse transcriptase inhibitors (NRTIs), particularly the thymidine analogs stavudine (d4T) and zidovudine (AZT).
These older NRTIs were found to induce mitochondrial toxicity. Mitochondria are responsible for generating energy within cells, including fat cells (adipocytes). The damage caused by these drugs is thought to impair the normal function and survival of adipocytes, leading to the gradual loss of subcutaneous fat tissue seen in lipoatrophy. The longer a person was on these specific medications, the greater the likelihood of developing these facial changes.
Some older protease inhibitors, another class of HIV medication, have also been implicated, though to a lesser extent. Modern antiretroviral therapy (ART) has evolved significantly. Newer drugs, such as integrase inhibitors and newer-generation protease inhibitors, have a much lower risk of causing lipodystrophy. This shift in treatment has made drug-induced facial changes a rare occurrence for individuals starting HIV therapy today.
The exact mechanisms are not fully understood, but it is believed a combination of the drug’s effect on fat cells, treatment duration, and genetic predispositions contributed to lipodystrophy. The inflammation caused by HIV itself might also play a role in how the body processes and stores fat, potentially increasing susceptibility.
Management and Treatment Strategies
For individuals experiencing facial lipodystrophy, a healthcare provider may recommend switching from an older antiretroviral regimen to a newer one. Changing the medication is a primary strategy. This can halt the progression of fat loss and, in some cases, may lead to modest improvements, particularly in limb lipoatrophy.
While changing medications is a fundamental part of management, it often does not fully reverse facial fat loss that has already occurred. To address the visible effects, cosmetic interventions are available to restore lost volume. These treatments focus on replenishing the areas where fat has diminished, such as the cheeks and temples.
Dermal fillers are a common and effective option. One widely used filler is poly-L-lactic acid (Sculptra). Unlike other fillers that simply add volume, poly-L-lactic acid works by stimulating the body’s own production of collagen over time. This gradually rebuilds the underlying structure of the skin for a more natural and longer-lasting restoration.
Another treatment strategy is autologous fat grafting. This surgical procedure involves harvesting a patient’s own fat from another area of the body, such as the abdomen or thighs, through liposuction. The fat is then purified and carefully injected into the hollowed areas of the face. This method uses the body’s own tissue to create a natural-looking and feeling result.