Given that facial lipoatrophy and other stigmatizing body-shape changes associated with lipodystrophy are caused in part by treatments for HIV, doesn’t the healthcare system have an ethical responsibility to provide and pay for restorative therapies? This question is raised in an August 20 editorial in AIDS, accompanying a research article showing that polyalkylimide gel (PAIG) injections are safe and effective for HIV-positive people with lipoatrophy.
According to both articles, posted on the National AIDS Treatment Advocacy Project (NATAP) website, a course of facial-filling injections for an average patient might be between $1,750 and $4,375. While PAIG might be a preferred treatment option due its permanency and reversibility in the event of side effects, David Margolis, MD, of the University of North Carolina, Chapel Hill, says of the Canadian study results, “sadly, the authors must conclude that treatment with polyalkylimide gel may be restricted due to its cost.”
PAIG is licensed only in Canada and Europe. In the United States, approved options include Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite). Unlike polyalkylimide gel, the U.S.-approved agents are temporary fillers and may require retreatment.