the currently available information comparing the medical and functional status of both cohorts in order to determine if there is any medical or functional basis (either mental or physical) on which SSA would evaluate the impairments of each of these cohorts differently when adjudicating their disability claims at age 18 under the HIV Infection Listing (14.08) for adults.
Response: Information regarding HIV-infected children’s medical and functional status can be found in Chapter 7. The incidence of perinatal infection has decreased greatly since the widespread use of antiretroviral therapy and aggressive testing; currently around 15,500 children live with HIV/AIDS as a result of increased survival (CDC, 2009). Prior to 1997, perinatal survival was low. In 1997, combination antiretroviral therapy became standard for treating children, leading to higher survival rates. As discussed in Chapter 7, children have benefited from advances in treatment in the same pattern as adults (McConnell et al., 2005). Combination antiretroviral therapy has resulted in reduced mortality, increased immune system functioning, and decreased complications from comorbidities and opportunistic diseases. Despite advances, challenges occur because options for therapy have been reduced as a result of multiple-resistance mutations. Little high-quality literature compares children of the above mentioned cohorts, and the committee found no literature indicating the cohorts should be treated differently when adjudicating claims.
Subtask 1B: The Consensus Committee shall survey published scientific literature, research, and studies to determine the following:
What published information (for example, medical and vocational literature) is available regarding the presence of chronic diarrhea in HIV-infected patients as an indicator of severity (both prognostically and functionally)?
How is chronic diarrhea in HIV-infected patients defined?
How is chronic diarrhea in HIV-infected patients documented?
What are the medical treatments for chronic diarrhea in HIV-infected patients?
How effective is treatment for diarrhea in HIV-infected patients?
What is the association between chronic diarrhea in HIV-infected patients and HIV wasting syndrome?
Response: The committee defined diarrhea as a change in an individual’s stool pattern with ≥ 3 stools per day that are loose or watery for ≥ 3 weeks (see Chapter 5). In the literature, diarrhea is often defined by