Complications of hyaluronic acid fillers in HIV-positive patients: A narrative review
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Abstract
Background: The introduction of antiretroviral therapy (ART) has improved the survival of people living with HIV, yet facial lipoatrophy remains a visible and stigmatizing complication. Hyaluronic acid (HA) fillers are widely used for volume restoration due to their safety, biocompatibility, and reversibility.
Objectives: This narrative review focuses exclusively on HA fillers in HIV-positive patients, aiming to clarify their complication profile.
Materials and methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2000-2024) identified 120 records. After screening and eligibility assessment, 13 studies were included. Data on study design, population, filler type, complications, and management were extracted and narratively synthesized, with results summarized in tabular form.
Results: Early adverse events, such as swelling and erythema, occurred in 50-80% of patients, and bruising in ~50%. Intermediate complications included nodules in 5-10% and indurations up to 30%, usually resolving with conservative management or hyaluronidase. Delayed infections (2-4%) were most often due to Staphylococcus epidermidis, Propionibacterium acnes, or atypical mycobacteria and required antibiotics or drainage. Granulomatous reactions and abscesses were rare (<5%) and typically occurred in patients with prior permanent filler exposure. No severe vascular events were reported in HIV-specific cohorts, though such risks remain relevant.
Conclusion: HA fillers are effective and generally safe for treating HIV-associated facial lipoatrophy, with most complications being mild and transient. However, immune dysregulation, low CD4 counts, and prior filler history may predispose to granulomas or infections. This review highlights the need for careful patient selection, meticulous technique, and further prospective research to establish standardized safety guidelines.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
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