also hold one or more outreach meetings, at which researchers, clinicians, patients, and patient representatives discuss specific impairments, focusing on how existing listings could be revised or on adding new listings. After these additional steps, SSA drafts proposed rules and publishes an NPRM for public comment before being issued Final Rules. It is important to note that revisions to listings apply only to new claimants, and are not applied retroactively to those previously allowed.

Since the development of the HIV Infection Listings in 1993, three ANPRMs have been published (2003, 2006, and 2008). SSA received comments ranging from specific edits (e.g., expand HIV encephalopathy to include AIDS dementia complex) to broader suggestions about the types of evidence collected and the expertise of disability examiners. Commenters also suggested that SSA recognize advances in care such as new manifestations and identification of clinical markers in the HIV Infection Listings. The committee reviewed all the public comments submitted in response to these notices and considered them over the course of its deliberations.

THE HIV INFECTION LISTINGS6

In 2009, 7,816 allowances were made based on meeting or medically equaling the HIV Infection Listings (14.08 and 114.08). The total number of claims involving the HIV Infection Listings has decreased steadily from approximately 30,000 claims in 1999 to approximately 25,000 in 2009, in part due to the changing management of HIV. The total allowance rate for all adult HIV infection claims fell from 39 percent in 1999 to 30 percent in 2009. For child claims involving HIV infection, the allowance rate declined from 26 percent in 1999 to 12 percent in 2009.

For 14.08, the number of allowances per sublisting has stayed somewhat steady from 1999 to 2009 (Figure 1-2), with a few exceptions. Allowances made under sublisting 14.08C (protozoan or helminthic infections) decreased in 2008, while 14.08B (fungal infections) increased dramatically. These changes can be attributed largely to a reclassification of Pneumocystis pneumonia from a protozoan to a fungal infection. Also, the number of allowances for malignant neoplasms increased from 1999 to 2009. These patterns are likely to change over time in response to the evolving management of the disease. Patterns in Step 3 allowances for Part B (114.08) could not be determined because the total number of claims was low, limiting their significance (Figure 1-3). The three most and least used 14.08 sublistings in 2009 are listed in Table 1-2.

For adults, allowances can be made on the basis of meeting the List-

6

All data from this section are derived from an unpublished data set provided by SSA. Data were current as of December 31, 2009.



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