In August, the Food and Drug Administration approved Sculptra, a new treatment for the facial wasting that can be a side effect of HIV drugs. Its maker, Dermik Laboratories of Berwyn, Pa., set the US price at almost four times the price in Europe, where it has been used since 1999. Sculptra sells for $125 per bottle in Europe and South America but $480 in the United States, said Dr. Peter Engelhard, director of Apex South Beach Clinic, which specializes in treating HIV atrophy. Each treatment requires two to three bottles; each patient needs three to six treatments; and one to two bottles are needed every one to years for maintenance treatments, Engelhard said.

Karen Boyce, Dermik's manager of communications, said the company is developing a patient-access program for those who cannot afford Sculptra; details should be available in late October. She noted that Sculptra is sold not to patients but to doctors; she suggested physicians could set lower prices for patients with hardships.

Engelhard said he had 170 patients on a waiting list before Sculptra was approved, but after approval and the price hike, all but 30 said they could not afford it. "They're either getting a different product or none at all. It's too bad because this is the best one," he said.

Insurance companies are unlikely to cover Sculptra because they consider it a cosmetic treatment, like Botox for wrinkles, Engelhard said. He disagrees, comparing it instead to reconstructive procedures following breast cancer surgery. "People do things like stop taking their medications because of atrophy, and that does change their longevity," he said.

Jonathan Appelbaum of Boston's Fenway Community Health said coverage by state drug assistance programs is also unlikely because Sculptra is considered a treatment or device, not a drug.