OBJECTIVES: Facial lipoatrophy is a significant problem related to antiretroviral therapy for people living with HIV. The only intervention currently available is the surgical correction with facial fillers. Objective of this study was to evaluate efficacy and efficiency of injection of various fillers: 1) poly-L-lactid acid; 2) polyacrylamide hydrogel; and 3) hyaluronic acid + tricalcium phosphate METHODS: Cost-effectiveness analysis (CEA) was performed on the results of a randomized controlled clinical trial comparing a surgical correction of lipoatrophy versus the usual clinical care without intervention, over six-month follow-up. Clinical information was collected with the facial lipoatrophy scale (possible score 0=normal,  to 3=severe lipodystrophy). Direct costs (costs of surgeon, fillers, chirurgical instruments) were evaluated from the service supplier’s perspective in Italy and analysed according to prices and tariffs applied in 2008.  Data from 67 patients per arm were collected at baseline and at 0-6 time points. RESULTS: Lipofilling intervention resulted in a lipoatrophy improvement, with a mean±SD change in facial lipoatrophy scale of -3.0±0.9. To implement this surgical procedure, service supplier should sustain an overall cost mean cost of  €2126.42 per patient, corresponding to an incremental cost-effectiveness ratio of €708.66 per unit of improved facial lipoatrophy. CONCLUSIONS: According to preliminary results, lipofilling intervention for lipoatrophy in HIV patients is cost-effective: to obtain a decrease of one grade of lipoatrophy, a cost of €708.66 is expected to be sustained. Information obtained with this study, can be helpful to make appropriate decisions for the provision of optimal health care for these patients.