On Tuesday, March 22, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of current policy to cover facial injections for beneficiaries suffering from hollowed cheeks as a result of HIV treatment.

Hollowed cheeks result from a condition known as facial lipodystrophy syndrome (LDS). LDS is a combination of localized fat loss (lipoatrophy), localized fat gain (lipodystrophy), and other metabolic abnormalities.

When highly active antiretroviral therapy (HAART) was introduced in the 1990s, patients began to experience LDS as a side effect of the therapy. Currently 13 to 38 percent of HIV patients are believed to develop LDS while taking the recommended HAART-dosing amounts.

Though the condition does not pose any significant health risk, LDS can have serious psychological consequences. Patients exhibiting the gaunt cheeks and sickly appearance associated with LDS may suffer from a negative self-image and depression.

In extreme cases, this psychological toll can cause a patient to discontinue treatment.

Under the expanded policy, CMS will cover the administration of synthetic “fillers” to patients showing symptoms of depression as a result of facial LDS.

Injected under the skin, fillers can make once-gaunt cheeks full again, potentially reversing the negative self-image and depression felt by patients. In addition, use of fillers can decrease the chances a patient will abandon HAART.

CMS reached this decision after studies showed that the use of fillers in HIV patients suffering from HAART-related LDS greatly improved their psychological condition.

Barry M. Straube, CMS chief medical officer and director of the agency’s Office of Clinical Standards and Quality, said “[This] decision marks an important milestone in Medicare’s coverage for HIV-infection therapies.”

Straube added that patients receiving the treatment should notice the improvement in their everyday lives. “Helping people living with HIV improve their self-image and comply with anti-HIV treatment can lead to better quality of life and, ultimately, improve the quality of care that beneficiaries receive.”

For more information on this new coverage, please see the CMS press release or Decision Memo.