Steve Stagon is a beautiful man, an eye-catcher in a crowd, whose handsome smile is a distraction from whatever he may be saying.
Steve is neither vain nor overly self-conscious. In the mirror, he sees his flaws rather than his assets, and as someone who has lived with HIV for many years, he is not happy with the distention of his torso at the core of an otherwise lean and perfectly proportioned body, maintained by careful diet and exercise. Steve is one of hundreds of thousands of men who wear the scarlet letter of their HIV infection.
HIV-associated lipodystrophy, the visible result of the virus and the drugs that treat it, is the redistribution of body fat, with fat disappearing from some areas (facial wasting) and increasing in other areas (bellies enlarged with visceral fat, and pads of fat on the back of the neck referred to as a "buffalo hump"). The social consequences of this disfigurement, and the painful marginalization of the stigmatized men whose HIV status is proclaimed by it, are distressing for its victims, but the condition can also be disabling, with life-challenging cardio-vascular results.
As Steve says, "After all I have been through and all I have survived, I do not want to let something like this kill me. This is not just about looks or vanity. This is about real health."
Steve is the moderator and facilitator of POZitive Attitudes, a topic-driven and peer-led support group for gay and bi men who are infected with or affected by HIV/AIDS. The group, which has been meeting every Wednesday for ten years, provides a confidential safe-space for sharing knowledge, friendship, support and social activities including dinners and movie nights. The group convened this week at the Pride Center in Wilton Manors for a presentation about EGRIFTA by Vernon F. Appleby, R.N., Director of Clinical Research with the practice of Dr. Gary J. Richmond. EGRIFTA is the first FDA-approved treatment for lipohypertrophy, the belly fat-specific manifestation of the lipodystrophy syndrome.
For many of the men in attendance who have been fighting HIV for much of their adult lives, and for whom lipodystrophy is a constant advertisement of their status, EGRIFTA may be a godsend.
Appleby discussed the differences between EGRIFTA and Serostim, a synthetic version of Human Growth Hormone that is FDA approved for the treatment of HIV-related wasting and weight loss. In its trials, Serostim also reversed the effects of lipodystrophy, but the FDA was not convinced that the risks associated with Serastim outweighed its benefits with lipodystrophy, and did not approve it for that purpose.
The differences between Serostim and EGRIFTA are significant. Serostim (generic name: somatropin) is a daily injection of a synthetic hormone that often comes with severe side effects including joint and muscle pain, swelling, and an increase in glucose levels in the bloodstream that can increase the risk of diabetes. The desired effects of Serostim begin to be visible after a few weeks on the drug, and the monthly cost is a staggering $10,000. EGRIFTA (generic name: tesamorelin) is a daily injection of a drug that causes the body to produce its own growth hormone. The possible side effects, including fluid retention, pain, rash and glucose intolerance, are mild in comparison to Serostim. The good results begin to be visible in three months, and the monthly cost of treatment is a less staggering $2,900.
EGRIFTA will not reverse facial wasting and will not increase arm or leg width. It does not address the kind of fat that is acquired through overeating and not exercising. It specifically targets fat surrounding the internal organs in the abdomen.
Appleby described the trials that led to the FDA approval of EGRIFTA. No one with an active malignancy was allowed to participate, and all participants had to be off Serostim for at least 6 months. Those in the study were also asked to follow a healthy diet and exercise routine. The critical results were calculated not in weight but in fat distribution measurements. Steve was one of the participants in those trials who experienced a satisfying reduction of his lipohypertrophy, and then its unfortunate return after the treatments ended.
Despite the fact that the FDA has approved EGRIFTA as a treatment for a syndrome that can be damaging to the cardio-vascular system, the biggest marketing hurdle is the refusal of many insurance companies to consider it anything more than a cosmetic treatment. Those insurers are also shortsighted in their refusal to see that erasing the scarlet letter of HIV infection will have a restorative impact on the daily lives of HIV-positive men, with an overall betterment of their health and a consequential lowering of other costly HIV-related treatments and medications covered by most health insurance providers. During the question and answer portion of the EGRIFTA seminar, some spoke about the unclear possibility of a patient assistance program and about current monthly co-pays that vary drastically from a few dollars to a reported high of $600. In the USA, EGRIFTA is distributed by Serono Laboratories and is not currently available at some of the national drug store chains. Many HIV doctors are still unfamiliar with EGRIFTA, and their patients are driving their continued education with requests for the treatment.
After the seminar, Steve reported that the attendees were satisfied that EGRIFTA's benefits are clear, as was the fact that there is little that can be done but wait for the drug's developer and marketer to battle successfully with health insurance companies that consider it an unnecessary cosmetic intervention, similar to liposuction.
At the POZitive Attitudes meeting, Appleby was preaching to the choir when he concluded his seminar by saying "The bottom line is that EGRIFTA is a good drug with few side effects."
(A version of this profile appeared recently in South Florida Gay News.)