in the Listing of Impairments (i.e., outside of Listings 14.08 and 114.08). An assessment of functioning should be completed in disability claims that present with (1) HIV-associated conditions, (2) adverse effects of treatment for HIV or comorbid conditions, or (3) other significant, documented symptoms (e.g., fatigue, malaise, pain). To account for the unpredictable nature of HIV and its treatment, allowances made under these parameters should be considered a disability for 3 years following the last documentation of the manifestation, adverse effects, or symptoms. This time period reflects the fact that HIV is now generally a manageable chronic disease and that the immunologic and functional status of many HIV claimants is likely to improve once they are engaged in care and receiving therapy. It should be noted that the benefits of therapy may decrease as comorbidities continue to develop, therefore requiring regular reevaluation.

RECOMMENDATION 4. Comorbidities induced by HIV infection or adverse effects of treatment should be considered disabling if they markedly limit functioning in one or more of the following areas: ability to perform activities of daily living; maintenance of social functioning; or completion of tasks in a timely manner due to deficiencies in concentration, persistence, or pace. This includes, but is not limited to, the following conditions:

  • Diarrhea;

  • Distal sensory polyneuropathy;

  • HIV-associated neurocognitive disorders;

  • HIV-associated wasting syndrome;

  • Kaposi’s sarcoma;

  • Lipoatrophy or lipohypertrophy; and

  • Osteoporosis.

Symptoms such as fatigue, malaise, and pain should also be considered if found to limit functioning. Periodically, SSA should reevaluate claims made using these comorbidities, consistent with the reevaluation of other disability allowances.

HIV-Associated Conditions With Listings Elsewhere

The committee identified a number of HIV-associated conditions with high morbidity and mortality currently represented in other sections of the Listing of Impairments. The prevalence of these diseases is growing among HIV-infected populations and will likely increase as these populations live longer. HIV infection typically results in an increased risk of developing comorbid conditions and an accelerated rate of progression to a severe or fatal outcome. However, the literature suggests the disability caused by co-morbid conditions is not usually clinically distinct and therefore is captured by other disability listings.

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