the following: (1) gastrointestinal dysfunction (malabsorption, AIDS enteropathy); (2) decreased dietary intake; (3) absence of HAART (leading to 0.9 kg reduction in body weight with each log increase in HIV viral load); (4) inflammatory cytokines, and (5) AIDS-defining conditions contribute, but “are not a major cause.” It has been suggested that wasting should be defined by loss of body mass, with bioelectrical impedance measuring change in body cell mass (Wanke et al., 2004). Another study found weight loss and wasting to be important comorbidities in patients receiving combination antiretroviral therapy, although the cause of weight loss was not determined (Tang et al., 2002). A longitudinal study of 1,474 HIV-infected patients showed that total body weight correlated directly with physical functioning, as reported by patients; specific weight reduction that would be disabling was not described (Wilson et al., 2002).

Subtask 1C: The Consensus Committee shall survey published scientific literature, research, and studies related to the opportunistic infections, cancers, or other conditions described in the criteria of immune system disorders listing 14.08 for adults with HIV infection to determine the following:

  • How has the treatment of these related conditions changed recently?

  • How effective are newer treatments for these conditions?

  • How available are newer treatments?

  • Are there indicators that these related conditions would prevent the ability to do any work for a continuous period of at least 12 months?

  • Are there indicators that these related conditions would be expected to result in death?

Response: The rates of opportunistic infections and cancers have decreased rapidly with widespread use of combination antiretroviral therapy. Chapter 2 described how opportunistic infections and cancers can continue to cause morbidity and mortality, but at much lower rates than at the beginning of the epidemic (Buchacz et al., 2010) (see Table C-1 in Appendix C). Some specific opportunistic infections, cancers, and other conditions can be expected to result in disability or death, as discussed in Chapters 46.1 In cases where opportunistic

1

Conditions discussed in Chapter 4 are HIV-associated dementia, multicentric Castleman’s disease, Kaposi’s sarcoma involving the pulmonary parenchyma, primary central nervous system lymphomas, primary effusion lymphoma, and progressive multifocal leukoencepha



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement