Lipodistrofia FACIAL
  
  
Corre磯 da lipoatrofia facial com solu磯 coloidal de polimetilmetacrilato (PMMA) em pacientes com HIV/AIDS.



Introdu磯:

A lipoatrofia facial tem sido observada, nos 䩭os 6 anos, em portadores de HIV/AIDS em uso de terapia anti-retroviral. Adquirindo aspectos inest鴩cos, esta lipoatrofia tem causado um grande impacto na qualidade de vida destes pacientes, interferindo na aderꮣia ao tratamento, al魠de comprometer o status psicossocial do paciente levando a uma diminui磯 da auto-estima.



Mat鲩as e M鴯dos:

Ap㠥xame cl�co, os pacientes eram submetidos a corre磯 da lipoatrofia facial atrav鳠de inje絥s retr粡das de solu磯 coloidal contendo PMMA. Esta solu磯 era composta de PMMA (Fig.2) a 30%, lidoca� a 1% em gel de celulose (Fig.3). A t飮ica de preenchimento utilizada foi de palitos paralelos e/ou em leque. Ap㠳0 dias os pacientes retornavam para avalia磯 cl�ca, e quando necessᲩo fazia-se preenchimento complementar. Neste momento os pacientes eram questionados sobre o grau de satisfa磯 com o preenchimento, e sobre o impacto psicossocial do tratamento, passando a ser acompanhado clinicamente.





Resultados I:

- 504 pacientes foram inclu�s neste estudo, 441 homens e 63 mulheres, com mediana de idade de 44,3 anos (21-73) e com acompanhamento m�mo de 1 m고e mḩmo de 5 anos.

- Tempo m餩o de sorodiagnose foi de 9,4 anos (1-20).

- CD4 variava de 10 a 1200 com mediana de 473 cels/mm3. (Fig.4)

Antes Ap㠶 meses Ap㠱 Ano



Resultados II:

- Os implantes faciais com PMMA demonstraram: serem duradouros; razoavelmente fᣥis de serem realizados; seguros e com excelentes resultados est鴩cos.

- Nenhuma infec磯, granuloma inflamat⩯, ou rea磯 al鲧ica foram observados nas Ქas tratadas.

- N㯠ocorreu nenhum efeito colateral que n㯠fosse esperado. Estes consistiram de incha篬 vermelhid㯠e hematoma, que melhoraram, na maior parte dos casos entre 3 a 5 dias sem medica磯 espec�ca(Fig. 5).

Antes Ap㠳 meses Ap㠳 Ano



Resultados II:

- Nenhuma altera磯 na contagem de CD4 pode ser relacionada com o tratamento.

- Alguns pacientes precisaram de novos tratamentos ap㠱2 a 18 meses, normalmente em Ქas diferentes das tratadas previamente.

- Os pacientes demonstraram estar satisfeitos com o tratamento e referiram melhora da qualidade de vida (Fig. 6).

Antes Depois



Antes Depois



Conclus峺

- O tratamento da atrofia facial com as inje絥s de PMMA demonstrou ser eficiente, duradouro e seguro;

- O tratamento teve uma influꮣia positiva sobre os pacientes, melhorando sua qualidade de vida e ajudando a recuperar sua auto-estima(Fig.8)

Antes Depois

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