here - CD8 T cells - The Body

More documents

Recommendations

Info

FAcE On: Berry before his initial treatment, and three months after the sixth and last session. facial lipoatrophy, but they are permanent and can sometimes cause serious side effects and allergic reactions (as can both Sculptra and Radiesse). Only one is FDA approved (Silikon 1000) and none are approved for use in HIV. Anecdotally, I’ve heard of people who have used them and are pleased with their results, but personally I did not want to use something that was going to be permanent. I felt comfortable using Sculptra because I had used it before and I already knew what to expect, but also because I would be getting six treatments instead of two, so I was hoping to experience better results this time around. Plus, as Dr. Berger explained it, after getting six treatments, my face would never go back to the way it was before receiving Sculptra, and I would only require a “touchup” session once a year. The cost of Sculptra is expensive, running about $1,700 for one kit (two vials), or $850 per 367.5 mg vial, which also includes the cost for the session—doctor, time, and procedure. Most insurance companies still consider its use to be a cosmetic treatment and are therefore likely to refuse to cover the drug as well as the procedure. However, if you are initially denied, you should appeal and see if you can get them to recognize it as a medical necessity (which it really is). Recognizing the high cost and lack of coverage by most plans, and the great need of those who have this condition, the manufacturer created a patient assistance program (PAP) for people with HIV that assists in helping to pay for Sculptra. However, a new company (Valeant) recently took over the PAP, and it now only covers those with up to $61,940 in annual income, and provides just two kits plus one follow up kit after a two-year period. Under the PAP Sculptra is free for those with an annual income less than 200% of the Federal Povery Level ($22,340 for an individual, slightly higher based on family size and in Alaska and Hawaii), and then on a sliding scale above this amount and up to $61,940. The staff at Northstar was very helpful in getting me set up with the PAP, and in November of 2011 I received my first treatment. IT IS VERY ImPoRTanT THaT THE physician who is performing the procedure be trained specifically in the use of Sculptra and how to properly inject it, which requires a certain threading, or tunneling, technique. According to the package label, “during the first injection session with Sculptra, only a limited correction should be made. The contour deficiency should be under-corrected, never fully corrected or overcorrected (overfilled) during any injection session. Re-evaluate the patient no sooner than two weeks after the injection session to determine if additional correction is needed.” Each session only takes around 40-45 minutes, and it would begin with Dr. Berger marking my face with a white pencil to guide him while injecting the Sculptra. Starting with ice packs on my face to minimize the swelling, and then a local anesthetic to numb my face, he would begin injecting the filler into different areas of my face, using his hands to help “move” the filler into place once it was injected. Even with the local anesthetic, I experienced a good deal of discomfort when the needles went in and he tunneled, especially during the first couple of sessions when there was little fat in my face for him to work with. But the discomfort was only temporary, and when the session was over, I was left with some temporary swelling, a few marks, and on occasion, some slight bruising, but the swelling went down in a few hours and any marks or bruising were gone within a day or two. Following each session, and according to the package label, I was to “massage in a circular fashion the treated areas for five minutes, five times per day for five days,” in an effort to stimulate collagen growth and “even out” the facial filler under my 42 SEPTEMBER+OCTOBER 2012 POSiTivElyAwARE.COM “AfTER” PHOTO: CHRiS KnigHT
SOuRCE: fACiAlwASTing.ORg FAcE OFF: Commonly used options for HIV-related facial lipoatrophy PRoDUcT TYPE/SESSIonS aPPRoVED? coST Sculptra Poly-L-lactic acid Radiesse Calcium hydroxylapatite (CaHA) microspheres Silikon 1000 Microdroplets Bioalcamid Polyalkylimide gel pMMA Polymethylmethacrylate skin. I went back for five more sessions, one every four weeks. Non-permanent; 3–7 or more sessions needed. Non-permanent; 2–3 or more sessions needed. Permanent; 4–6 or more sessions needed. Permanent; 1–2 sessions needed. Permanent; 1–2 sessions needed. PaTIEnTS aRE aDVISED THaT after the initial treatment and within a week the effects will completely disappear, and the contour of the face returns to how it was before. With each subsequent session, however, you begin to see the cumulative benefit of each successive treatment, and the effects are more noticeable and last longer. By the third or fourth treatment, I was really looking more and more like my old self, and couldn’t wait for each following treatment, pain or no pain! Treatment advocate Nelson Vergel warns that not everyone experiences the same level of results. “Some people in my online discussion group, especially those with moderate to more advanced cases of facial lipoatrophy, have complained of poor response with Sculptra after spending a few thousand dollars for several sessions that did not end up restoring their faces.” Vergel, founder of FacialWasting.org and pozhealth at yahoogroups.com, says that some of them end up getting silicone microdroplets in the U.S. or flying to Mexico to get permanent options like PMMA (see table, above). FDA approved. Patient Assistance for product only (under $61,940 yearly income): www.needymeds.org/papforms/ sculpt1039.pdf. Labor cost average $400 per session. Full price: $1,100 per session for product. FDA approved. Patient Assistance available: www. radiesse-fl.com/Physician-section/ Patient-access-program/ Full price: $1,200 per session. Off-label use; FDA approved for intraocular injections to treat CMV-related retinal detachment. Not FDA approved. Available in Canada, Mexico, and Europe. Not FDA approved. Available in Mexico and Brazil. American version Artefil is too expensive for the amount required. Of course, nothing is perfect, and there are side effects associated with Sculptra. The most common side effects reported in studies are bruising, swelling, discomfort, and rash, but these typically resolve within a few days to a few weeks. There is a “device-related adverse event” called an injection site subcutaneous papule, which is a small lump or bump under the skin, the onset of which can occur anywhere from a few weeks to a few years afterward. I experienced several of these lumps, one under my left eye, and two under my right temple (sometimes if you get these papules you can feel them under your skin, but they are barely noticeable—other times they can be more visible). There are also more serious adverse events that can potentially occur, so be sure to read the full package label. In THE EnD, FoR mE THE FEw small lumps, the cost of treatment, and the pain were all a small price to pay for what it has ultimately done for my self-esteem. I feel better about myself overall, because I look healthier. The effect for me was subtle, most people didn’t really notice or say anything, other than “you look rested” or “you look really great!” No Patient Assistance Program. $400–800 per session, depending on the physician. $4,500 average total. Two sessions. Infections reported after 3–4 years. $2,000 average cost for total reconstruction. Patient assistance in Tijuana: www.MedicalPMMA.com I realize that I am very lucky to have a decent-paying job that has afforded me the ability to benefit from this treatment, and that many others are not as fortunate. I also realize that even though the HIV treatments available today are much less likely to cause facial lipoatrophy (if at all), the fear of developing facial lipoatrophy still may deter some people from ever starting treatment, or may cause those who are on treatment to be less than fully adherent to their regimen. While Medicare finally agreed to cover the procedure a few years ago, the amount that they reimburse is well below what providers charge. That is why I plan to continue to advocate for insurance companies, Medicare, and Medicaid to cover this procedure at a reasonable amount, much in the same way that breast reconstruction is provided to women with breast cancer who have undergone a mastectomy. The benefit of these treatments is vital to the psychological well-being and quality of life for so many people living with HIV who are affected by this condition. go to www.sculptra.us for more information. For a list of providers trained in the use of Sculptra, visit www.sculptraaesthetic.com. POSiTivElyAwARE.COM SEPTEMBER+OCTOBER 2012 43
Page 1 and 2: positivelyaware.com september+octob
Page 3 and 4: IS THE PREZISTA ® EXPERIENCE RIGHT
Page 5 and 6: • steroids such as dexamethasone,
Page 7 and 8: SEP+OCT 2012 VoLUmE 24 nUmBER 6 dep
Page 9 and 10: PHOTO: CHRiS KnigHT EdITOR’S nOTE
Page 11 and 12: Please turn past this page; it has
Page 13 and 14: Please turn past this page; it has
Page 15 and 16: PHOTO: JOSHuA THORnE BRIEFLY EnID V
Page 17 and 18: FRom THE wEEkLY E-nEwS Website offe
Page 19 and 20: PHOTO: MATTHEw gARSTECK TPan, publi
Page 21 and 22: Save up to $200 per month Before ta
Page 23 and 24: Also tell your healthcare provider
Page 25 and 26: Naina Khanna, Director of Policy an
Page 27 and 28: HIV care is more than just medical
Page 29 and 30: It appears, for example, that the c
Page 31 and 32: SyStem’ negotiate safe sex practi
Page 33 and 34: h day while pregnant, especially du
Page 35 and 36: ARE yOu AWAre? gET PosITIvely AWAre
Page 37 and 38: and the multiple molecular mechanis
Page 39 and 40: PHOTO: © iAS/RyAn RAyBuRn-COMMERCi
Page 41 and 42: were discovered today, it would tak
Page 43: the mirror haS tWo faceS A personal
Page 47 and 48: PHOTO: CHERyl MAnn WhOLISTIC PICTuR

here - CD8 T cells - The Body

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?