BOX 4-1

Immediately Fatal or Severely Disabling Conditions

Documented presence of one of the following conditions ought to be considered a permanent disability:

  • HIV-associated dementia;

  • Multicentric Castleman’s disease;

  • Kaposi’s sarcoma involving the pulmonary parenchyma;

  • Primary central nervous system lymphomas;

  • Primary effusion lymphoma; or

  • Progressive multifocal leukoencephalopathy.

HIV-Associated Dementia

HIV-associated dementia (also known as AIDS dementia complex, HIV dementia, or HIV encephalopathy) is part of the spectrum of HIV-associated neurocognitive disorders (HANDs), discussed in Chapter 5. It refers to severe impairment (measured as performance greater than two standard deviations below normal) in at least two cognitive domains that extremely limits everyday functioning (Antinori et al., 2007). The main features are disabling cognitive impairment accompanied by motor dysfunction, speech problems, and behavioral change. This results in an inability to carry out more than the most basic activities of daily living independently (e.g., eating, bathing, dressing) and an inability to work.

Before the introduction of combination antiretroviral therapy, the mean survival of patients with HIV-associated dementia was 3 to 6 months; marginal improvement lasting over several months may be gained through use of combination antiretroviral therapy (Tozzi et al., 2007). Incidence of HAND in developed countries has declined ten-fold as a result of combination antiretroviral therapy (Bhaskaran et al., 2008; Kaul, 2009). HIV-associated dementia by definition qualifies as a severely disabling condition and is observed in 5 percent or fewer of HIV-infected persons (Heaton et al., 2009).

HIV-associated dementia typically occurs after years of HIV infection and is associated with low CD4 levels and high plasma viral loads. Diagnosis can be made by a clinician based on a mental status evaluation assessing the domains of cognitive functioning.

Although HIV encephalopathy is currently considered under sublistings 14.08G and 114.08G, the term is no longer widely used in the treatment of adults infected with HIV. HIV-associated dementia is characterized by

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