Use of Intralesional Deoxycholic Acid for Antiretroviral Treatment Associated Lipohypertrophy: A Qualitative Open-Label Study of an Innovative Indication

Vinay Kulkarni; Tejaswini S Salunke; Ambarish G Mandhane; Pradyumna Vaidya

doi:10.4103/JCAS.JCAS_150_22

Use of Intralesional Deoxycholic Acid for Antiretroviral Treatment Associated Lipohypertrophy: A Qualitative Open-Label Study of an Innovative Indication

J Cutan Aesthet Surg. 2023 Apr-Jun;16(2):134-139. doi: 10.4103/JCAS.JCAS_150_22.

Authors

Vinay Kulkarni¹, Tejaswini S Salunke¹, Ambarish G Mandhane¹, Pradyumna Vaidya¹

Affiliation

¹ Department of Dermatology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.

Abstract

Background: With the advent of antiretroviral treatment (ART), human immunodeficiency virus/AIDS has become a chronic manageable disease. Though life expectancy has improved, it brings alongside effects of long-term medical treatment. One of the major side effects is body dysmorphism, which leads to esthetic problems. Problems of lipodystrophy (LDS), especially facial lipoatrophy as well as facial and upper back lipohypertrophy are perceived by patients as highly stigmatizing manifestations of their human immunodeficiency virus infection. It has been reported to affect mood and quality of life, as well as reduced adherence to antiretroviral medications. Patients feel discomfort while sleeping, dressing, and during day-to-day activities.

Aim: The aim of this study was to test a relatively cost-effective and efficacious treatment modality for long-standing ART-associated lipohypertrophy of the submental fat and dorsocervical fat.

Materials and methods: This was a prospective open-label clinical study, in which 21 patients on regular ART with associated lipohypertrophy were enrolled in this open-label study. Deoxycholic acid (DCA) was given intralesionally once every 4-6 weeks. Patients were assessed for response, any adverse events, and patient satisfaction during every visit.

Results: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions.

Limitations: It was a small-sized sample that was studied. The lag time between starting the treatment and optimum results was long in comparison with liposuction. The result is better appreciated at the end of treatment rather than after every session implying that it has a cumulative effect. Neither pre- and post-ultrasonography nor metric documentation was done.

Conclusions: Intralesional DCA seems to be a promising treatment modality for long-standing ART-induced LDS with better cost-benefit in comparison with surgical interventions.

Keywords: ART induced lipohypertrophy; HIV-induced lipohypertrophy; buffalo fat; dorsocervical fat; double chin; intralesional deoxycholic acid; submental fat.