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HIV and Disability: Updating the Social Security Listings
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 scientificliterature, research, and studies related to the opportunistic infections,cancers, or other conditions described in the criteria of immune systemdisorders listing 14.08 for adults with HIV infection to determine thefollowing:
How has the treatment of these related conditions changedrecently?
How effective are newer treatments for these conditions?
How available are newer treatments?
Are there indicators that these related conditions would preventthe ability to do any work for a continuous period of at least 12months?
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 4–6.1 In cases where opportunistic
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