December 5, 2013
When interviewed by the doctors, three patients recalled first noticing the initial signs of CVG about a decade ago, as ridges appeared on their scalp. In the fourth patient, the ridges appeared two years ago. However, all patients noticed that ridges appeared on their scalps only after they developed the HIV lipodystrophy syndrome. These ridges did not go away when massaged.
In most cases, lab analyses of the men's blood were within normal ranges for cholesterol, liver enzymes, protein, testosterone, estrogen and thyroid-stimulating hormone (TSH). However, doctors discovered that all the men had relatively high levels of glucose (sugar) in their blood; three patients were approaching pre-diabetic levels or even higher, and one patient's glucose levels were within the range seen in people with diabetes. All assessments of blood glucose were done when the men were fasting. Furthermore, levels of the hormone insulin in the blood (drawn when the patients were fasting) were higher than the upper limit of normal in three patients.
Surgery is a standard approach for treating CVG in HIV-negative people. However, surgery, particularly in HIV-positive people, carries the risk of infections developing in places where the skin was cut. As an alternative, in one patient a doctor injected his scalp with the substance poly-L-lactic acid (PLA, Sculptra, NewFill). This is commonly used in plastic surgery as, once it is emplaced in the skin, PLA can trigger the formation of collagen and helps to raise depressions. After several injections given five weeks apart, the man's furrows decreased in depth, without the appearance of any complications. PLA tends to degrade within a couple of years after emplacement so repeated injections may be necessary.
CVG is relatively rare in people, with only 500 cases reported prior to the year 2003. The reasons for the four cases of CVG in these HIV-positive adults are not known, but it is possible that a combination of several factors -- including disturbances of insulin and other hormones, perhaps related to the HIV lipodystrophy syndrome and even unknown genetic factors -- may have played a role. CVG does not appear to have been previously reported in HIV-positive people in the English language medical literature.
Now that the San Francisco doctors have published their report, hopefully other doctors caring for HIV-positive people may be more vigilant for any appearance of CVG and more research into this strange condition can be conducted.
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