About AIDS

Possible treatment for facial wasting

A gaunt face – sunken cheeks, deep creases, loose skin, protruding cheekbones – is a fairly common side-effect of long-term HIV treatment, particularly among men. It's "facial wasting," a type of fat loss called lipoatrophy that is part of the broader syndrome called lipodystrophy. Now, a more effective treatment called Sculptra is available, which may significantly reduce facial wasting.

In August, the FDA finally approved poly-L-lactic acid (PLLA, or Sculptra in the U.S.) for correcting HIV-related facial wasting. Fortunately, its long European track record (as "NewFill") addresses questions about effectiveness and safety. Unlike "plumping" compounds, such as Aquamid (Contura in the U.S.), PLLA does not fill in the area itself. Rather, it is injected just below the skin and stimulates the production of natural collagen to replace the lost fat.

Patients may need three to five treatments over several months, to be administered by a trained cosmetic surgeon. Results may last a couple of years or longer, but it eventually will have to be repeated. Usually, the most noticeable side effects are temporary injection-site soreness, redness, or swelling.

Sculptra's biggest downside is cost. A treatment cycle is several thousand dollars, and insurance companies will not pay for it; they regard it as optional, cosmetic surgery. Companies are beginning to soften their stance, as advocates are able to convince them that treatment for facial wasting is restorative, rather than merely cosmetic. (I spoke last week with a PWA here in Austin whose major insurance company had just paid for it.) AIDS advocates are pressing the manufacturer, European drug giant Aventis, and their U.S. partner, Dermik Labs from Pennsylvania, to develop a patient-access program (i.e., free or discounted product).

Lipoatrophy is no fun, but PLLA offers another, improved option toward its resolution. For added information, check www.aidsinfo.nih.gov/drugs/htmldrug_nt.asp?int_id=0403 or www.facialwasting.org.

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