Current evidence on the efficacy of deep dermal injection of non-absorbable gel polymer (NAGP) for HIV-related facial lipoatrophy is adequate. With regard to safety, infections that may need surgical removal of the implant are a risk in the longer term and other complications, including granuloma formation and migration, are common. Therefore, this procedure should be performed only with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake deep dermal injection of non-absorbable gel polymer for HIV-related facial lipoatrophy should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand that complications may occur in the short or long term – specifically infection, granuloma formation and migration – and that the implant may need to be removed. They should inform patients about the range of treatment options available. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having deep dermal injection of non-absorbable gel polymer for HIV-related facial lipoatrophy (see section 3.1).
Clinicians using this procedure should be trained in the technique of injecting non-absorbable gel polymers. Injection should be carried out with strict aseptic technique in an appropriate environment.
Further research and publication of observational data would be useful. Publications should describe details of patient selection, particularly in relation to previous treatments. They should also describe clinical outcomes (including all complications) and patient experience in the longer term. NICE may review the procedure on publication of further evidence.