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HIV and Disability: Updating the Social Security Listings
cognitive or motor dysfunction that limits ability to perform daily functions and therefore should be considered a severely disabling condition in Part A of the HIV Infection Listing.
Multicentric Castleman’s Disease
Multicentric Castleman’s disease (MCD) resembles advanced-stage non-Hodgkin’s lymphoma, with diffuse nodal involvement and “B” symptoms, although the proliferative tissue is histologically inflammatory, but benign. MCD can affect the liver and spleen. It has been associated with high levels of the marker of immune activation interleukin-6.
Like Kaposi’s sarcoma, multicentric Castleman’s disease is associated with infection by the human herpesvirus-8 (HHV-8). Unlike Kaposi’s, however, widespread availability of combination antiretroviral therapy has not led to decreased prevalence of this disease. The prognosis for multicentric Castleman’s disease is poor, with an overall mortality rate of 44 percent (Mylona et al., 2008). However, advances in therapy have led to longer survival; a recent study of 21 patients found a 2-year survival rate of 95 percent with rituximab (Bower et al., 2007). Malignancies have been reported in 32 percent of patients (Bowne et al., 1999; Newlon et al., 2007). The disease occurs more frequently in men and in people ages 30 through 50. Although MCD is uncommon in pediatric populations, children may have better outcomes than adults (Newlon et al., 2007; Parez et al., 1999).
Diagnosing multicentric Castleman’s disease has many uncertainties because it exhibits nonspecific characteristics and can mimic other neoplasms. Definitive diagnosis can be made by surgical resection and histopathologic findings showing B-cell proliferation. While the Epstein-Barr virus (EBV) is not consistently associated with MCD, HHV-8 infection is nearly universal. Combined chemotherapy is recommended for patients with good health status; however, those with poor health status should be considered for treatment with steroids and single-agent chemotherapy. Rituximab and antiretroviral therapy both may be effective (Stebbing et al., 2008; Sullivan et al., 2008).
Multicentric Castleman’s disease is not specifically indicated in the current Listing of Impairments. However, given its severity in those infected with HIV, the disease should be considered in the HIV Infection Listings.
Kaposi’s Sarcoma Involving the Pulmonary Parenchyma
Kaposi’s sarcoma is a fatal condition when it manifests in the lungs, where it tends to grow as sheets of tumor tissue in the peribronchial and perivascular axial interstitial spaces. Chest radiographs typically show a patchy infiltrating process. The disease is commonly multifocal and pleural