CD4 Count/Any procedure for Lipoatrophy?
Dec 1, 2009
Hi....My CD4s have always been somewhat low since I was diagnosed with HIV in 1992. I suffer from severe lipoatrophy (limited to my face). My latest CD4 count was 19. Do I run a greater risk of infection if I were to have ANY kind of procedure performed for Lipoatrophy? At what point are CD4s TOO LOW for treatment? Thank you.
Response from Dr. Pierone
Hello, and thanks for posting.
With an absolute CD4+ lymphocyte count of 19 you would be at greater risk of infection from any procedure to treat lipoatrophy.
The good news is that the risk of infection from facial fillers is very low to begin with. The rare infections that I have seen following injections of Sculptra, Radiesse, and hyaluronic acid fillers (Juvederm, etc) have been mild and respond to oral antibiotics. An exception is Bioalcamid -- infections related to this implant are more serious and usually require a procedure to remove the filler.
Your situation is unusual. In our large HIV practice we have no patients with a CD4+ lymphocyte count below 100 if they have been on effective antiretroviral treatment for more than 6 months. So it would make sense to optimize viral control if your viral load is not undetectable. Also look at your regimen to see if anything is suppressing your CD4+ lymphocyte count (ddI tenofovir combination for example).
I would like to see the CD4+ lymphocyte count over 100 to treat with facial fillers. But in an extraordinary situation I would consider treating with a patient with lower counts.
I hope that this information helps and best of luck to you!
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