here - CD8 T cells - The Body

the mirror haS
tWo faceS
A personal account of using facial filler for lipoatrophy
by Jeff berry
eVER SIncE IT FIRST BEgan aPPEaRIng wITH
some regularity in people with HIV in the mid 1990’s,
lipoatrophy has earned its well deserved reputation
as the Scarlet Letter of HIV, also known as “the look.”
Lipoatrophy is the loss of subcutaneous fat under the skin, most
notably in the face, but also in the butt, arms, and legs, and is
thought to be part of a larger syndrome called lipodystrophy,
which is the redistribution of fat in the body and can include buffalo
hump, enlarged breasts, and visceral fat in the abdomen.
It can sometimes be extremely disfiguring,
and almost always causes some level
of emotional distress, even depression,
and oftentimes self-imposed isolation in
those who suffer from its stigmatizing
effects. It can also affect adherence to HIV
medications, and deter people from starting
treatment in the first place.
The cause of lipoatrophy has been
linked to certain HIV medications, most
notably d4T (Zerit, stavudine) and to a lesser
extent AZT (Retrovir, zidovudine) and
ddI (Videx, didanosine); other HIV meds,
including some protease inhibitors; and it
has also been linked to HIV itself. D4T is
rarely prescribed in the U.S. anymore, but is
still widely used in many developing countries
due to its availability and low cost.
While we don’t see as many new cases of
lipoatrophy here in the U.S. with those who
have since initiated therapy using newer
and less-toxic antiretrovirals, it is still prevalent
among those using d4T in developing
countries, although d4T continues to fall
out of favor with providers and is used less
and less as more and newer drugs become
available in those regions.
For those who have been treated with
some of these older, more toxic drugs
(when that was all that was available),
many have developed the sunken cheeks,
veiny arms and legs, and loss of fat in the
butt to the point where it is uncomfortable
to sit for more than a short period of time.
Once you discontinue taking a drug like
d4T, you can sometimes stop the lipoatrophy
from progressing any further, but it
can take a long time to see any reversal of
its effects, if ever, so some people will turn
to using facial fillers to replace the fat in
the face that has been lost.
I have written several articles in the
past, for both PoSITIVELY awaRE and
TheBody.com, about my experiences
dealing with the physical and emotional
aspects of having lipoatrophy and its
stigmatizing effects, as well as my experience
using a facial filler, Sculptra (known
then as New-Fill) back in 2001. The results
I saw in 2001 were only moderate, and
disappeared within about six months to
a year, mainly due to the fact that I only
received two treatments because that was
all that I could afford.
In THE FaLL oF LaST YEaR, I
decided to revisit the idea of receiving
another round of facial filler
treatments, and I went to see Dr. Dan
Berger of Northstar Medical Center in
Chicago for a consultation. Dr. Berger, who
also writes for PoSITIVELY awaRE, and
has over 12 years of experience providing
Sculptra, recommended that I undergo
five or six “sessions” due to the level of
facial lipoatrophy that I had. Facial lipoatrophy
is graded on a scale of 1 to 5, with 1
being mild, and 5 being severe—mine was
severe, between grade 4 and 5. During
each session, I was to receive injections of
two vials, or one “kit” of Sculptra, one vial
for each side of my face.
Sculptra, or injectable poly-L-lactic
acid, is one of only two FDA approved
treatments in the U.S. for HIV-associated
facial lipoatrophy, the other being
Radiesse. Both of these injectables work
by being absorbed into the body and
stimulating the growth of the body’s own
collagen, so they are not permanent fillers.
There are other fillers available (see
table, page 43) that are also used for
POSiTivElyAwARE.COM SEPTEMBER+OCTOBER 2012 41