[Facial lipodystrophy in patients with HIV infections troublesome to treat].

HIV-infection is now a treatable chronic disease. The lipodystrophy syndrome, which is a common complication of treatment, is characterized by peripheral lipoatrophy, central lipohypertrophy, hyperlipidemia and insulin resistance. The underlying mechanisms are still poorly understood, but the combination of protease inhibitors with nucleoside analogs seems to induce complicated metabolic disturbances. From the patient's point of view, facial atrophy is the most stigmatizing aspect of the syndrome and might badly influence treatment adherence, crucial for long term antiviral efficacy. We propose a topographical classification and grading of facial lipoatrophy, and describe local treatment with injectable hyaluronic acid in gel form. The problem with such injections is their high cost. Since hyaluronic acid injections are not covered by the usual government subsidy for prescription medicines, ways of financing such treatments should be sought.