effusions are common. These are typically hemorrhagic, but cytologically benign. The most common symptoms are progressive dyspnea, nonproductive cough, and fever.

Even with the use of combination antiretroviral therapy, survival for pulmonary Kaposi’s sarcoma has been shown to be 4 to 19 months (Hannon et al., 1998; Holkova et al., 2001; Palmieri et al., 2006). Approximately 20 percent of deaths related to pulmonary Kaposi’s sarcoma are due to complications of the disease, such as upper airway obstruction or parenchymal destruction (Gasparetto et al., 2009; Restrepo et al., 2006).

Pulmonary Kaposi’s sarcoma is diagnosed through a combination of tests (clinical, radiographic, and laboratory) and specifically by bronchoscopy and transbronchial biopsy (Aboulafia, 2000; Gasparetto et al., 2009).

Kaposi’s sarcoma in the pulmonary parenchyma is currently considered as part of sublistings 14.08E2b and 114.08E2b. The committee concludes that due to the aggressive and fatal nature of pulmonary Kaposi’s sarcoma, it needs to be retained in the HIV Infection Listings and should be considered a permanent disability.

Primary Central Nervous System Lymphomas

Primary central nervous system lymphomas are aggressive B-cell, non-Hodgkin’s lymphomas arising within the central nervous system (CNS). Although uncommon, they are associated with advanced stages of HIV-induced immunodeficiency. The peripheral CD4 count is in the 0 to 50 cells/mm3 range. EBV infection is almost invariably demonstrated in the CNS. Prognosis is extremely poor even with the initiation of combination antiretroviral therapy.

This therapy has resulted in decreased incidence and increased median survival for HIV-infected patients with primary CNS lymphomas (Bower et al., 2006). With antiretroviral therapy, 2-year survival increased to 29 percent (Biggar et al., 2005) with a median survival of 8 to 18 months (Diamond et al., 2006; Hoffmann et al., 2001).

Magnetic resonance imaging (MRI) or contrast-enhanced computed tomography (CT) usually show multiple lesions in almost any location, but usually deep in the white matter of the brain in the periventricular region.

Unlike lymphomas listed in 13.05 and 113.05, these lymphomas specifically impair people living with advanced stages of immunodeficiency. Therefore they should be considered under the HIV Infection Listings and should be provided permanent disability because of the severity of the disease.



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