# Polyacrylamide Injection vs. Polylactic Acid in HIV Related Lipodystrophy: A RCT Systematic Review
###### Abstract  
Lipodystrophy is an alteration of fat metabolism that commonly affects HIV-1 positive patients treated with antiretroviral therapy (ART). The facial area is most commonly affected by peripheral lipoatrophy, thus becoming a social stigma related to chronic HIV. Several treatments have been proposed, such as modification of diet, lifestyle and both surgical and nonsurgical procedures. The goal of our systematic review is to examine published clinical studies involving the use of polyacrylamide filler for the treatment of HIV FLA, and to provide evidence-based recommendations based on published efficacy and safety data. Our research was performed on published literature until April 2021. Polyacrylamide gel is a volumetric gel that has been proven stable, nontoxic, nonallenggenic, nonenenprostoxic and nonabsorbable. Poly-l-lactic acid (PLA) is a biocompatible, biodegradable, synthetic polymer derived from lactic acid. We believe it is essential to draft a pre- and post-injection and operative protocol to define an even setting for the clinical condition. It is desirable that such specifications are included in a large randomized controlled trial and the follow up is longer than the studies that we found, because as we have seen in the literature there are reported adverse events even 3 or 5 years after the injections. HIV facial lipoatrophy; HIV lipodystrophy; facial volume loss; filler agent; highly active antiretroviral therapy; quality of life; polyacrylamide gel; polylactic acid +
Footnote †: journal: Medical-Surgical and Dental Specialites, Oral and Maxillofacial Surgery Unit, University of Campania \"[PERSON]\", Via [PERSON], 6, 80138 Naples, Italy; [EMAIL_ADDRESS] (G.T. ); [EMAIL_ADDRESS] (R.F. ); [EMAIL_ADDRESS] (G.C.) Footnote †: journal: Medical-Surgical and Dental Specialites, Oral and Maxillofacial Surgery Unit, University of Campania \"[PERSON]\", [PERSON], 6, 80138 Naples, Italy; [EMAIL_ADDRESS] (G.T. ); romolofragola@gmail. consequences may be significant in many patients, leading to reduced self-esteem, problems in social and sexual relations, anxiety and depression, as a result leading to a reduction in antiretroviral therapy adherence [2; 6; 7; 8]. Several treatments have been proposed, such as the modification of diet, lifestyle and both surgical and nonsurgical procedures [9; 10; 11; 12; 13; 14; 15]. If the clinical condition is characterized by facial lipoatrophy and body lipohypertrophy, structural fat grafting may be a feasible option, since it is possible to restore the face volume and reshape the body at the same time [16; 17]. On the other hand, if the clinical condition is mainly characterized by facial lipoatrophy, other options are available, such as the use of permanent, semipermanent or absorbable fillers [9; 18; 19]. Polyacrylamide gel was first introduced in aesthetic medicine in Ukraine in the late 1980s [20]. Today, it is mainly produced by Contura International with the trade name Aquamid, though other producers of polyacrylamide exist on the market [Argiform (Bioform, Moscow, Russia), Amazingel (NanFeng Medical Science and Technology Development Co., Ltd., Shijiazhuang, People's Republic of China), Bio-formacryl (Polymekon, Brindisi, Italy), Bioalcamid (Polymekon, Brindisi, Italy). The features of this gel make it a versatile tool, being used in female stress urinary incontinence, osteoarthritis and cosmetics, specifically in lip volume enhancement and facial contouring [21; 22]. Polyacrylamide application is a minimally invasive and effective procedure, but possible complications related to the injection are reported, such as migration of the gel, fibrosis and visible accumulations [23]. Surgical intervention could be needed to deal with these cases [23; 24], and for these reasons polyacrylamide is still not approved in many countries. Polymlectic acid (PLA) is an aliphatic polymer derived from lactic acid, and since 1970 it has been approved by the Food and Drug Administration (FDA) for direct contact with biological fluids.