• Acknowledge that the ability to manage HIV infection has improved considerably, but a number of severe complications associated with HIV infection can persist and can be disabling;

• Address the possible adverse effects of treatment, which can become chronic and disabling; and

• Recognize that CD4 ≤ 50 cells/mm³ is a surrogate marker of immune function in HIV-infected individuals and can indicate chronic disability and generally poor outcomes (e.g., progressive disability).

The technical overview portion envisioned by the committee would describe specifics about the sublistings to help disability examiners, medical consultants, and adjudicators make decisions based on the HIV Infection Listings. This portion would include definitions and specific clinical details of disease manifestations. Although the language will be necessarily technical, it needs to be written in a clear and simple manner.

The committee recognizes the desire for the sublistings to avoid repetition of the introduction, but it learned that the introductory text and sublistings are not always used together. Therefore, definitions of the manifestations identified in previous chapters should be considered for inclusion in both the sublistings and the introduction.

To facilitate use of the Listing of Impairments, a cross-index ought to be developed that includes hyperlinks to the Internet version of the Listings. This would make them more user friendly for the public.

Understanding of the effects of HIV disease and its associated conditions and treatment is continuously evolving. As HIV-infected persons are living longer on effective treatment regimens, new sources of illness are likely to develop. For example, the effects of HIV and treatments on cardiovascular disease and cognition are now emerging. To best meet claimants’ needs, the Listings ought to continuously reflect advances in the clinical understanding of how HIV and its treatments affect health.