Treating sunken cheeks

Case Scenario

A 65-YEAR-OLD man, diagnosed with HIV since 1994, presents with severe facial hollowness requesting treatment (Figure 1). He feels he is looking increasingly gaunt despite enjoying stable and good health. He is very self-conscious of the way he looks and had fat transfer several years ago without success. His current medications are Kaletra (lopinavir/ritonavir), nevirapine and lamivudine (highly active antiretroviral therapy). On examination, there is significant hollowness in both the cheeks and temples with prominent nasolabial folds. There is also fat loss on the upper and lower limbs and fat accumulation in the parotid and abdominal areas. What is this man suffering from and what are the management options?

Facial HIV lipoatrophy

Facial HIV lipoatrophy is a stigmatising condition that can be cosmetically disfiguring. The pathogenesis of this condition involves antiretroviral therapy, HIV-1