C (Soriano et al., 2002; Sulkowski, 2004). Whether combination antiretroviral therapy improves liver function in those coinfected with either HBV or HCV remains unclear, but it does slow hepatitis progression. Coinfection is also an indication to initiate HIV therapy at an early stage of HIV infection.

Hepatitis is discussed in the Digestive System Listings (specifically, chronic liver disease is covered in Listings 5.05 and 105.05). The committee suggests editorial changes be made within 5.00 and 105.00, the introductory text that describes chronic viral hepatitis infections (specifically 5.00D4 and 105.00D4), to better reflect the current state of hepatitis care. This includes stating that HIV infection may accelerate the clinical course of viral hepatitis infection and patients infected with HIV may have a poorer response to treatment instead of simply stating that it may affect the clinical course of disease; including hepatitis B virus DNA as a method of diagnosing hepatitis B infection; revising “hepatitis B envelope antigen” to “hepatitis B early antigen” or “hepatitis B ‘e’ antigen”; adding “hepatocellular carcinoma” to end-stage liver disease and cirrhosis as a condition with increased risk of progression; and removing “combination of interferon injections” as a method of suppressing hepatitis B virus. Because HIV and hepatitis coinfection does not necessarily redefine the level of disability but instead causes people to reach the same level of disease severity more quickly, cross-referencing to Listings 5.05 and 105.05 is appropriate for HIV-infected claimants also living with hepatitis.

Malignancies Not Otherwise Specified

Cancers in people living with HIV/AIDS can be fatal and can lead to high levels of morbidity. These conditions have been classified into two groups: AIDS-defining cancers and non-AIDS–defining cancers. AIDS-defining cancers, as identified by the Centers for Disease Control and Prevention, are Kaposi’s sarcoma, invasive cervical cancer, and non-Hodgkin’s lymphoma, both those arising within the central nervous system (CNS) and ones arising peripheral to that site. Non-AIDS–defining cancers are all other cancers that manifest in HIV-infected persons. Some malignancies are specifically discussed in prior chapters—primary CNS lymphomas (Chapter 4), Kaposi’s sarcoma (Chapters 4 and 5), and primary effusion lymphoma (Chapter 4)—because of the aggressive nature of the condition or because they are still relatively common clinical conditions despite the wide use of antiretroviral therapy.

Since the development of potent combination antiretroviral therapy, the incidence of AIDS-defining cancers has dramatically decreased (Brodt et al., 1997; Buchacz et al., 2010; Grulich et al., 2001; Rabkin et al., 1993). However, non-AIDS–defining cancers are increasingly common, whether



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