Up to 19 percent of people who received Bio-Alcamid (polyalkylimide) for HIV-related facial wasting (lipoatrophy) at a Toronto clinic experienced injection-site infections, according to a report presented at the 12th International Workshop on Adverse Drug Reactions and Comorbidities, held November 4 to 6 in London, and highlighted in the December issue of HIV i-Base. The sobering results of this case review have prompted the study researchers to warn doctors not to recommend Bio-Alcamid for lipoatrophy.

Bio-Alcamid is a polymer gel that has been used during the past several years, predominantly in Europe, Canada, South America and Mexico, to treat fat loss in the face and buttocks. Bio-Alcamid’s advantages over other available treatments were the facts that it lasted longer and could be used in larger volumes, thus allowing fewer touch-ups.

In 2009, a published report from the Netherlands indicated that roughly 5 percent of people who’d been treated with Bio-Alcamid later developed an infection at the site of the application. Bio-Alcamid works by provoking the body to produce collagen that encloses the gel and keeps it from being absorbed. Though the product’s maker, Polymekon, initially claimed that there was little danger that the collagen pockets could become infected, the Dutch study indicated otherwise.

To further examine the danger of infectious complications from the drug, researchers from the University of Toronto examined data on 263 HIV-positive people who had received the treatment at a Toronto clinic. Most of the study volunteers were men, and nearly all receive the treatments in the cheeks or temples of their faces.

Despite the fact that an antibiotic was used during and after treatment, 19 percent reported an infectious complication in the months following treatment.

An infection was confirmed as “definitely due” to the treatment in 25 percent of those with an infection—5 percent of all those treated—and “probably due” to the treatment in the remaining three quarters of those with an infection—14 percent of all treated. Though many developed an infection due to trauma near the area of the injection site, most commonly during dental work, some infections occurred spontaneously.

Of the 17 people in whom tissue was sent for analysis, 13 (76 percent) had a confirmed bacterial infection. Roughly half of those who had an infectious complication had their Bio-Alcamid surgically removed; the rest received only antibiotic treatment.

Though Bio-Alcamid is used far less frequently since reports began surfacing about problems with the products during the past couple of years, the authors state their data confirm that the treatment should no longer be used to treat fat wasting in people with HIV. They did not, however, advise that people who already received Bio-Alcamid treatment have the product surgically removed.