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Federal Government Approves Funding For The Treatment Of HIV Related Facial Lipoatrophy (FL)

Thu, 16/06/2011 - 4:59pm — admin

The Government announced the approval for funding the medical procedure to inject Sculptra in the May Budget. The announcement has allowed the Minister for Health to make the necessary arrangements that have been announced in a ‘Determination', or official government document. Below is part of the Ministers Determination that will allow people to claim the cost of treatment from Medicare from the 1st of July 2011.

Health Insurance (Facial Injections of Poly-L-lactic acid) Determination 2011

The purpose of the Determination is to enable the payment of Medicare benefits for the medical procedure to inject poly-L-lactic acid (Sculptra®)
for the treatment of severe facial Lipoatrophy caused by antiretroviral therapy in HIV positive patients.

Two new Medicare Benefits Schedule (MBS) items will provide for the following services for eligible patients:
The initiation of a course of treatment, limited to one injection session (item 14201);
Subsequent injection sessions, up to a maximum of four adjustment treatments, followed by one maintenance injection session every two years (item 14202).

What is HIV treatment related Facial Lipoatrophy?

HIV treatment-related Facial Lipoatrophy (FL) is a term that describes the loss of fat from parts of the face as a result of taking certain HIV treatments, the effects of HIV itself and smoking. Lipoatrophy literally means loss (atrophy) of fat (lipo). FL is also referred to as "Facial Wasting" or more often just "Lipo".

Although not a life threatening health issue, people with FL often experience depression, anxiety an loss of self esteem as a result of changes to their appearance. People can also feel stigmatised and ‘outed' as being HIV positive because of their looks, and therefore feel reluctant to socialise or work.

People who receive treatment to correct the symptoms of FL report major improvements in their psychological well-being. Following treatment people often resume social, work, study and volunteering opportunities. The diagram below shows the progress of FL.

What causes FL?

Although the causes of FL are not fully understood, it is thought that some HIV treatments cause fat loss in certain areas of the body, particularly in the face. It is thought that these treatments damage the energy-producing structures of collagen cells called mitochondria, resulting in a loss of collagen - the substance that gives our face a full and youthful appearance.

When many collagen cells in one area are affected, the overall shape of that area can change giving areas of the face a ‘shrunken' appearance. If you are concerned that any of your HIV treatments may cause FL you should talk to your doctor. Other factors that contribute to FL include the effects of the virus itself, the length of time spent living with HIV, the length of time that the person has taken the treatments that contribute to FL, and smoking cigarettes or anything.

What can I do?

The progress of FL is usually gradual so if you notice any changes to the appearance or shape of your face you should talk to your doctor as soon as possible who may recommend a change your treatment combination. Once the contributing treatment is ceased, FL will usually stop progressing.

Unfortunately FL does not ‘resolve' or reverse itself. A number of clinical trials have been carried out to see if taking certain medications can restore cells to their original shape, so far there have been no promising results. Please follow this link for further information.

What other treatment options are available?

One of the more popular and successful methods of treating FL is injecting substances known as Dermal Fillers. Dermal, or facial, fillers restore the shape of the face by ‘plumping up' the affected area to its original shape.

How much do dermal fillers cost?

In September 2009 the Medicare Pharmaceutical Benefits Scheme (PBS) agreed to subsidise the cost of a product for the treatment of FL, called Sculptra. The PBS is the department of Medicare that funds the cost of approved medications, leaving only a "co-payment" to be paid for by the person buying the medication.

The co-payment is paid at the pharmacy when the medication is dispensed. As of 1 January 2011, the cost of the co-payment is $34.20 for most medicines listed o the PBS. People with health concession cards pay a co-payment of $5.60.

The newly approved product is called Sculptra, also known as Newfill. It is made from a substance known as poly-L-lactic acid, a synthetic material that has been used safely for over 10 years. The company that produces Sculptra has a website for people considering this type of treatment. www.lipoatrophy.com.au

How effective is the treatment?

Results can vary from person to person with some people needing fewer injections and ‘top-ups' than others. Here are a few comments from people that have shared their experiences with ACON.

‘R' said: "Having lived with HIV for a long time I had just accepted my facial lipo. Even though the medications that cause FL aren't used any more, I am very grateful that they have saved my life. Being a little older now I was aware that the lipo was making me look even older than I am, so I decided to have the treatment.
I can't tell you what a difference the treatment has made to my looks and confidence. I am going out more and meeting new people. I have started volunteering for an HIV organisation and am even thinking about returning to study or part time work".

‘L' said: "I am very health conscious and like to take care of myself, but no matter how much I worked out, wore sunscreen and took care of my skin my FL made me look much older than I was. Since I have had the treatment people can't believe the difference that it has made. Although I am in my early forties people say that I look ten years younger. I feel more alive, happier and healthier. The improvement in my mood has been so dramatic that my doctor has been able to take me off my antidepressant medication. I highly recommend this treatment to anyone".

How do I access treatment?

You will need a referral from your HIV Doctor to see another Doctor qualified to administer Sculptra who with write an "Authority Prescription" for Sculptra. An Authority Prescription is needed for many specialised areas of medical care, and in this case can only be written by a doctor who has undergone training to administer Sculptra. Check with your HIV Doctor, as some are also qualified to prescribe and administer Sculptra

Please follow this guide that describes the steps needed to access treatment for FL.

STEP	ACTION	NOTES
1	See your HIV doctor or GP for a referral to a doctor accredited to prescribe Sculptra - let’s call them a “Sculptra Doctor”.	Some HIV doctors are able to prescribe and administer Sculptra, so check with your clinic first.
2	Make an appointment with your Sculptra Doctor for an assessment to see if you qualify for an Authority Prescription. If you qualify, you will be given a script for the product.	A prescription can only be issued to people who fulfil the requirement of having ‘severe HIV treatment-related facial lipoatrophy’.
3	Fill your prescription at a pharmacy that stocks Sculptra; not all pharmacies do. Check with your Sculptra Doctor first or refer to the list below.	As of January 2010 the co-payment for a prescription is $33.30, or $5.40 if you hold a health concession card.
	Important - do not fill your script until you have made an appointment for your treatment.	If you fill your script too early your Sculptra might go out of date (expire) and won’t be able to be used.
4	Make an appointment with a qualified Sculptra Doctor to undergo your procedure. Ask your HIV doctor who they would recommend or follow this link to a list of certified practitioners.	You may need to shop around to find the best deal. Some doctors will charge less than others. Some doctors will prefer to give the treatment over several sessions. Others might be able to do so with fewer appointments thereby saving you time and money.

Where can I get treatment?

Below is a list of doctors qualified to treat FL located in Sydney. This information was accurate at the time of writing, and is by no means fully comprehensive. This information is not intended to be an endorsement of the Doctors or clinics listed, nor is the list in any particular order, although we have received positive feedback from people who have received treatment for FL by these Doctors.

People with concession cards or on low incomes may be able to negotiate fees or payment over time. Please remember to always check with your Doctor or clinic of choice to confirm costs before making an appointment for treatment.

Other doctors may Bulk Bill or negotiate rates for people on benefits or low incomes. Ask around to find out what others know. Your HIV Doctor may also have further information. If you are aware of other Sculptra doctors who are willing to negotiate their fees please contact the writer of this article. Your local ACON branch, other HIV organisations or your HIV doctor may know of other qualified doctors in your area.

Please follow this link to the part of the www.lipoatrophy.com.au website that hosts a comprehensive list of Doctors qualified to administer Sculptra.

If you know of other Doctors that you can recommend please email treatments@acon.org.au so that we can include them on our list.

List of doctors

Dr David Baker of East Sydney Doctors is a HIV Prescriber as well as a qualified Sculptra Doctor
Some clients have reported that Dr Baker will Bulk Bill for some people, depending on their income. Please call the clinic to make enquiries about fees and referral processes.
East Sydney Doctors
102 Burton Street, near the corner of Forbes St
East Sydney NSW 2010
Phone: 02 9332 2531 or 9331 7953
www.eastsydneydoctors.com.au
Dr Linda Dayan is a HIV Doctor as well as a qualified Sculptra Doctor who works at Taylor Square Private Clinic.
For information about referral and billing arrangements please contact clinic reception.
Taylor Square Private Clinic
393 Bourke St Taylor Square Darlinghurst 2010
Phone: (02) 9331 6151
reception@tspc.com.au
www.tspc.com.au

Dr Dick Quan is a HIV Prescriber as well as a qualified Sculptra Doctor.
Please call the clinic to make enquiries about fees and referral processes.
Holdsworth House
Suite 1 / 32a Oxford St Darlinghurst, NSW 2010
Phone: (02) 9331 7228
info@holdsworthhouse.com.au
www.holdsworthhouse.com.au
Dr Steven Liew of the Shape Clinic
Will offer Bulk Billing for the procedure for people who hold a Centrelink Health Care Card. This service will be available once the item number for the procedure has been approved by Medicare.
Shape Clinic
Suite 109, 19a Boundary Street Darlinghurst NSW 2010
Phone: 8356 2888
www.shapeclinic.com.au
Dr Andrew Roberts
Will charge $250.00 per treatment, and may negotiate bulk billing once an item number is approved.
Cosmetic Medical Centre
426 Crown Street Surry Hills NSW 2010
Phone: 02 9357 7333
www.cosmeticmedical.com.au
info@cosmeticmedical.com.au
Skin and Cancer Foundation Australia
You may be able to negotiate costs or pay over time.
www.scfa.edu.au
Darlinghurst
277 Bourke Street, Darlinghurst
02 8833 3000
Westmead
7 Ashley Lane, Westmead
02 8833 3000
The Peach Cosmetic Medicine Clinic
Charges $95 ($66 rebate from Medicare) for your initial consultation and $250 for each treatment session. Please contact the clinic to ask if you are eligible for a rebate for treatment.
Peach Cosmetic Medicine
330 Oxford Street Paddington NSW 2021
Ph: 9368 0100
www.peachcosmeticmedicine.com
The All Saints Cosmedical Clinics
Llocated at Taylor Square and Parramatta. They will Bulk Bill for people on benefits, and may also make arrangements for people with HIV on low incomes, please call to confirm billing arrangements. You will also need to call to ask for the name of the Doctor who will be treating you for your referral.
www.allsaintscosmedical.com.au
Taylor Square
Suite 302 / 393 Bourke Street , Darlinghurst NSW 2151
Tel 02 9357 7557
Parramatta
13A Buller Street, North Parramatta NSW 2151
Tel 02 9890 9977

Other treatments you might consider for FL

Fat Transfer

Fat is transplanted from one area of the body to another. Since the fat comes from your own body, there is no risk of rejection or experiencing an allergic reaction. Possible side effects include swelling, bruising, and lumpiness. Treatment lasts approximately 6 to 12 months before the fat is re-absorbed by the body. Please follow this link for further information.

Collagen Stimulation

This process involves injecting one of a number of medically approved substances that stimulate the growth of collagen. Results are not instant but build up over time, and can last for up to 2 years. Please follow this link for further information.

Dermal Implant

A support device is implanted surgically into the area requiring treatment. Side effects can be those normally associated with surgery, however the results are permanent. Please follow this link for further information.

New Developments

At last years IAS (International AIDS Society) conference the results of a trial of a new product were presented. The product, called Eutrophill, was given to 111 people who participated in a clinical trial in France. All participants reported improvement in appearance and self esteem with no significant side effects identified. Eutrophill has an estimated shelf life of 5 years, suggesting that top-up treatments would be required less often than for other products. Please follow this link to the IAS presentation abstract.

Please follow this link to the Lipoatrophy Resource Centre hosted at thebody.com