HIV and Disability Updating the Social Security Listings (2010) / Chapter Skim
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3 Low CD4 Count as an Indicator of Disability
3 Low CD4 Count as an Indicator of Disability
Pages 45-52
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From page 45... ...
In the absence of such evidence, the committee considered measures predictive of disease progression, morbidity, and mortality, which, in the expert assessment of the committee, could be taken as surrogate markers of disability. Two laboratory markers, CD4 count and HIV-1 viral load, are a routine part of HIV clinical care and recommended by all primary care guidelines.
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From page 46... ...
The viral load, on the other hand, indicates the production rate of HIV virions and expected rate of subsequent CD4 cell destruction. Although CD4 count is the central means of staging the disease in HIV infection, the viral load is the most accurate means of following the success or failure of antiretroviral therapy.
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From page 47... ...
As the CD4 count continues to fall, which it does inevitably in the absence of antiretroviral therapy, HIV-infected persons have an accelerated risk of a wide range of opportunistic diseases, all with serious morbidity, many rapidly fatal, unless immune deficiency is reversed with HIV suppression. In the time before current combination antiretroviral therapy, an HIV-infected adult with a CD4 ≤ 50 cells/mm3 had approximately a 45 percent 12-month mortality rate without therapy (Yarchoan et al., 1991)
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From page 48... ...
All cohorts defined postcombination antiretroviral therapy as after 2000. SOURCES: Agan et al., 2010; Justice et al., 2010; Mocroft and the EuroSIDA Study Group, 2010.
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From page 49... ...
can be accurately measured by polymerase chain reaction or other nucleic acid detection methods. Most assays can accurately detect and reproducibly quantitate viral loads greater than 50 copies/mL.
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From page 50... ...
Although the viral load has been used in the diagnosis of acute HIV infection before the appearance of serum HIV antibodies, its primary application is in monitoring response to antiretroviral therapy. Viral load is expected to decline rapidly once therapy is initiated and to drop to levels of less than 50 copies/mL after 12 to 24 weeks of treatment.
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From page 51... ...
After a period of time, if the claimant's CD4 count is greater than 50 cells/mm3, the claim should be reevaluated to determine whether the person continues to be disabled according to other components of the HIV Infection Listings, including sublistings estimating functional status. Since antiretroviral treatment often allows clinical improvement over a period of 1 or 2 years, the committee believes claimants allowed under such a listing should be reevaluated periodically for disability status.
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From page 52... ...
2001. Virologic outcome and predictors of virologic failure of highly active antiretroviral therapy containing protease inhibitors.
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