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lipodystrophy and which meds cause them
Dec 24, 2007

Im currently on meds norvir 100mg, epzicom 600/300, Viread 300 mg, rayataz 300. I have phase 3 facial lipodystrophy and viral load of less than 75, Tcells 960

I have been on meds for 1996 Sept.

I have been these meds for two years. I know Im doing well but am concerned about my face. Which treatment for the wasting is best? there are about ten out there. Which proceedure would pose the least risk or which meds should I try replacing to reduce the facial wasting. Sculptra This is the first facial reconstruction product approved in the U.S. for HIV-related lipoatrophy. The product is injected under the skin by a trained professional, usually a dermatologist or plastic surgeon. It requires three to six sessions with 21 days between each session and a touch-up every year. The product costs $980 per session plus the doctor fee ($250-$500 per session). Dermik, the manufacturer, has a good patient assistance program. For more information, go to www.sculptra.com .

Radiesse This product may soon receive FDA approval for use in the correction of facial lipoatrophy in HIV+ people. Radiesse contains man-made calcium hydroxylapatite, a substance found in bones and teeth. It is currently approved in the U.S. for various uses, including reconstructive surgery and dentistry, and has a good safety record. Radiesse is considered to be a temporary filler, meaning that its cosmetic benefits decrease over time, usually within a few years of receiving the injections. It can be very expensive at up to $3,000 per office visit. The company will offer patient assistance but details are unknown at the present.

Bioalcamid This product is not approved in the U.S., but is available in Europe, Mexico, Canada, and other countries. Patients have been going to Mexico and Canada to get it. It is a permanent filler and usually requires one or two sessions at a total cost of $4,500. No patient assistance program is available in the U.S.

Silikon 1000 This product is not approved for lipoatrophy, but is commonly used by doctors off label for this purpose. Unlike the way silicone was used in the past, this product is injected in very small quantities (micro droplets) which require anywhere from three to six sessions depending on the severity of the facial wasting. The average cost per session is around $700.

PMMA This product is not approved in the U.S. Patients have been traveling to Rio de Janeiro and Mexico to obtain it. It is a permanent solution that usually requires two sessions. Total cost in Rio can range from $1,000 to 2,000. (PMMA has also been used in Rio to treat lipoatrophy of the butt.)

The long-term effects of these treatments are unknown. Some treatments are not permanent and results can vary. They can also be costly, and many insurance companies will not provide coverage. If you are planning on using a treatment, and especially if you plan to go outside of the U.S. for treatment, check with the products manufacturer to make sure your provider has been properly trained to perform the procedure.

Response from Dr. Henry

I cannot recommend one of the products you list over the other since data from well done long term comparative studies is lacking. often the decision comes down to cost, availability, and experience of the plastic surgeon. Your current regimen has a low over all short/moderate term risk for lipoatrophy though there may be a few individuals who are more susceptible to that problem. Often fat loss was partly due to previous regimens and if fat cells died then recovery /reversal may not occur or be very slow once the offending drugs are stopped. Age, time with HIV, lower CD4 nadir and other non treatment factors contribute to the risk for lipodystrophy. KH



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