Although widely accepted measures of HIV functional impairments are limited, a strong relationship exists between advanced immune impairment and clinical outcomes, including mortality. The committee concludes that a threshold can be drawn at CD4 ≤ 50 cells/mm3 as an indicator of disability. Because CD4 count can change in response to antiretroviral therapy, claimants allowed disability under such a listing should be periodically reevaluated. The committee believes 3 years would allow for a sustained response and is the maximum practical period for SSA reassessment.

RECOMMENDATION 1. SSA should use CD4 count as an indicator of disability. Specifically, CD4 ≤ 50 cells/mm3is an indicator that a claimant’s HIV infection is disabling. This allowance should be reevaluated periodically by SSA.

Imminently Fatal or Severely Disabling HIV-Associated Conditions

A number of imminently fatal or severely disabling HIV-associated conditions exist, even in the era of potent antiretroviral therapy. These rare but very aggressive diseases will likely lead to death or severe disability within a year and patients are unlikely to improve. Although much less common than early in the epidemic, these generally untreatable conditions resemble the AIDS-defining infections or cancers that were considered appropriate for disability allowance in the current listing. The committee therefore concludes that claimants with these conditions need to be considered separately from other HIV infection claimants and that these conditions should be specifically included in the HIV Infection Listings as permanent disabilities.

RECOMMENDATION 2. SSA should make disability determination allowances permanent for imminently fatal and/or severely disabling HIV-associated conditions. These conditions may be appropriate as compassionate allowances. These include the following:

  • HIV-associated dementia;

  • Multicentric Castleman’s disease;

  • Kaposi’s sarcoma involving the pulmonary parenchyma;

  • Primary central nervous system lymphomas;

  • Primary effusion lymphoma; and

  • Progressive multifocal leukoencephalopathy.

Other Severe HIV-Associated Conditions

A new set of nonimminently fatal medical conditions associated with HIV infection has emerged in recent years. Among these are conditions also seen in the general population, including cardiovascular disease and

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