HIV-associated asymptomatic neurocognitive impairment (HIV ANI) exists when mild cognitive decline, ascertained by neuropsychological performance 1 to less than 2 standard deviations below expectation, is documented, but there is no documentation of impairment in everyday functioning. Some cases report exerting greater effort to maintain performance, but do not require other accommodation. This category is listed for completeness, but HIV ANI does not qualify for Social Security disability.
In the case of MND, which may be observed in about 25 percent of HIV-infected persons (Heaton et al., 2010), there is not total disability. However, mild to moderate disability of MND may combine with other sources of functional impairment (e.g., severe neuropathy, marked mood change, severe fatigue due to treatment, or comorbid conditions such as hepatitis C) to produce an overall picture of severe functional impairment. Because these conditions are specific to HIV, HIV-associated mild neurocognitive disorder should be included in the HIV Infection Listings when marked functional limitations can be demonstrated.
“HIV wasting” is an AIDS-defining condition that is defined as an involuntary loss of more than 10 percent baseline body weight that is accompanied by chronic fever, fatigue, or diarrhea for at least 30 days (CDC, 1992). Although this is the definition most often used in the literature, it may lead to underreporting of AIDS in the more recent era of combination antiretroviral therapy (Siddiqui et al., 2009).
Involuntary weight loss in patients with HIV infection has shown a consistent correlation with morbidity and mortality. This weight loss has been reported in patients treated with combination antiretroviral therapy, including patients who have HIV suppression and CD4 counts above 200 cells/mm3, although this combination is unusual (Mangili et al., 2006; Tang et al., 2002; Uhlenkott et al., 2008).
HIV-associated wasting syndrome is defined by the committee as an involuntary weight loss of 10 percent and a body mass index (BMI) less than 18.5 (the BMI that is the standard metric used to define malnutrition). The use of a 10 percent involuntary reduction in body weight is based on multiple reports that consistently show a correlation between death and this level of weight loss. These include reports in the postcombination antiretroviral therapy era.
The causes of involuntary weight loss are not specified, but they have been studied extensively and appear to be “multifactorial.” The main causes are inadequate caloric intake and altered metabolism. Contributing