Medicare administrators are offering a proposal to use approved injectable fillers to treat people with HIV who have facial wasting—but only if they provide proof that their facial wasting lead to depression. People may send public comments to Medicare officials on this proposal until January 22.

Facial wasting (lipoatrophy) is primarily a side effect of certain antiretroviral (ARV) drugs—predominantly Zerit (stavudine) and Retrovir (zidovudine). Though people taking these drugs can generally halt facial wasting by switching to other ARVs, the condition is not usually reversible.

The U.S. Food and Drug Administration (FDA) has approved two fillers to treat HIV-related facial lipoatrophy: Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite). Both fillers are only temporary and have to be readministered, however, and are not currently covered by government insurance programs such as Medicare and Medicaid.

Last year, the Medicare administration issued a call for public comments regarding a proposal for Medicare to cover treatment of HIV-related facial lipoatrophy with either of the two approved treatments. Now Medicare is proposing coverage of such treatment, but with the requirement that depression is also present.

According to the proposal, detailed in a December 23, 2009, memo, “Dermal injections for facial [lipoatrophy] syndrome are only reasonable and necessary using dermal fillers approved by FDA for this purpose, and then only in HIV-infected beneficiaries who manifest depression secondary to the physical stigmata of HIV treatment. All other indications are noncovered.”

People who wish to comment on this proposed decision, and share their story or the story of a loved one who has suffered from facial lipoatrophy, may do so by clicking here.