Fat loss from the face is one of the components of lipodystrophy, the name used to describe a syndrome of body fat changes seen in people taking anti-HIV drugs. Wasting of fat from the face usually occurs together with other changes in body shape and with an increase in the amount of fat in the blood, but it can be the only aspect of lipodystrophy which a person experiences.

Causes

It’s not known exactly what causes fat to waste from the faces of some people taking anti-HIV drugs, but it’s thought that about 13% to 48% of people taking anti-HIV drugs will experience it, depending on their prior and current antiretroviral regimens. At first it was thought that protease inhibitors were the cause, but most doctors now believe that it is caused by nucleoside analogues, particularly d4T (stavudine, Zerit) and to a lesser extent AZT (retrovir). Because of the link with d4T the British HIV Association no longer recommends the use of d4T if there are other treatment options available. Similarly, use of AZT is now discouraged if there are other drugs available.

Other factors have also been suggested as a possible cause of fat wasting from the face. These include severe immune system damage before anti-HIV treatments were started, low body weight, age over 50 years, and being male.

Characteristics

Facial wasting can occur rapidly after starting anti-HIV therapy, often within three months.

Fat wastes away from the fat pad in the cheek, below the cheekbone and beside the nose. This can make a person look very hollow-cheeked, gaunt, or ill. Fat is also often lost from the small fat deposits in the temples.

Health implications

Facial wasting itself is not dangerous. If it is accompanied by increases in blood fat, these can increase the risk of problems such as heart disease and stroke.

Facial wasting can have a very serious impact on emotional and mental health. Many people with facial wasting feel stigmatised, feel that their body fat changes reveal that they are HIV-positive, and lose self-confidence.

It has also been suggested that some people do not take their anti-HIV treatments properly either in the hope that their facial wasting will go, or to prevent it developing in the first place.

Preventing facial wasting

It isn’t exactly known how to prevent fat loss from the face. However, two drugs have been particularly associated with fat loss. These are d4T, and to a lesser extent AZT. Because of this neither d4T nor AZT are recommended for use in initial anti-HIV drug combinations, and if you are already taking d4T or AZT and have other drug options open to you, then you may be advised to switch treatment.

Starting anti-HIV treatment before your CD4 cell count drops too low may also reduce your chances of experiencing facial wasting.

It’s also possible that your genes may play a role, meaning that you are naturally more or less likely to experience body shape changes.

Reversing facial wasting

A study has found that people who switched from d4T to abacavir or tenofovir experienced modest fat gain over three years.

As it’s not know exactly what the cause of facial wasting is or how to reverse it, there has been a move towards the use of reconstructive surgery which is intended to fill out the sunken cheeks of people with facial wasting.

A number of surgical procedures are being investigated, and the use of polylactic acid, better known as New Fill has received a lot of attention.

Studies in the UK and abroad have shown that New Fill can reverse the appearance of facial wasting, leading to an improvement in people’s self esteem and confidence.

New Fill is administered by a course of injections into the cheeks, normally spaced over six weeks. The injections encourage skin growth and fill-out the sunken areas. Most people have three to five sets of injections, and it’s thought that the effects of New Fill last for around two years. Treatment appears to be safe, with the most frequently reported side-effect being inflammation in the area where the injections were administered.

Access to New Fill from the NHS is limited, but it is hoped that as more evidence emerges about its effectiveness, it will become more widely available. It is possible to obtain private New Fill treatment, costing between £600-£1,800, depending on the practitioner and how many treatments you need.

Other cosmetic treatments for facial wasting that are being examined include fat-transfer, collagen, and hyaluronic acid.