HIV and Disability Updating the Social Security Listings (2010) / Chapter Skim
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5 HIV-Associated Conditions Without Listings Elsewhere
5 HIV-Associated Conditions Without Listings Elsewhere
Pages 63-76
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From page 63... ...
THE IMPORTANCE OF FUNCTIONING IN DETERMINING DISABILITY As discussed later in this chapter, the committee believes that in the era of potent antiretroviral therapy, the presence of an opportunistic infection or a manifestation of HIV alone is insufficient to declare a person unable to work. For instance, adverse effects of treatment can affect one's ability to work (e.g., interferon therapy for hepatitis C leads to malaise and fever)
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From page 64... ...
The committee found disability examiners to be familiar with the requirements, generally to like this sublisting, and to be fairly comfortable using it. This is supported by the fact that sublisting 14.08K provides the second most BOX 5-1 List of HIV-Associated Conditions Without Current Listings Elsewhere in the Listing of Impairments Comorbidities induced by HIV and its treatment currently without listings else where include, but are not limited to: • Diarrhea; • Distal sensory polyneuropathy; • HIV-associated neurocognitive disorders; • HIV-associated wasting syndrome; • Kaposi's sarcoma; • Lipoatrophy or lipohypertrophy; and • Osteoporosis.
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From page 65... ...
CONDITIONS CURRENTLY WITHOUT LISTINGS Advances in treatment have reduced the frequency of many opportunistic infections and manifestations currently in the HIV Infection Listings. These infections and manifestations are generally less common, no longer necessarily permanently debilitating, or less predictive of disability than they were in 1993 when the HIV Infection Listings were developed.
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From page 66... ...
Therefore, the committee determined diarrhea should be included in the HIV Infection Listings when associated with marked limitation in functioning. Distal Sensory Polyneuropathy Peripheral neuropathy is a disease of the peripheral nervous system, associated with pain, weakness, and sensations such as burning and numb
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From page 67... ...
With a wide range of symptoms, peripheral neuropathy is difficult to diagnose, requiring a neurologic examination. The exact etiology of distal sensory polyneuropathy is unknown, but as indicated above, it is associated with HIV infection, antiretroviral therapy, or possibly comorbid conditions such as hepatitis C coinfection (Ellis et al., 2008)
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From page 68... ...
refers to presentations with at least two areas of neurocognitive com promise, but the severity is less than with HAD. The effect on everyday functioning is less severe than with HAD; typically the individual manages basic activities of daily living, but needs some assistance or accommodation in more demanding activities.
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From page 69... ...
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.
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From page 70... ...
Because of the increased risk of mortality and a potential impact on quality of life and functioning, the committee concludes that HIV wasting syndrome should be included in the HIV Infection Listings to the extent that they cover substantial involuntary weight loss that markedly impairs functioning. Kaposi's Sarcoma In HIV-infected persons, Kaposi's sarcoma (KS)
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From page 71... ...
With more advancedstage disease, or in those with incomplete response to antiretroviral therapy, systemic chemotherapy can be helpful to control the condition, and some topical agents occasionally are used as well. KS can, however, remain a serious and disabling condition despite treatment, especially in cases exhibiting visceral disease or bulky cutaneous involvement.
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From page 72... ...
. Both lipoatrophy and lipohypertrophy are conditions specific to the treatment of HIV/AIDS and are not found in other sections of the Listing of Impairments; therefore, they should be considered under the HIV Infection Listings when associated with marked functional limitation, including stigma that can be limiting in the workplace.
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From page 73... ...
HIV-ASSOCIATED CONDITIONS IN THE LISTINGS HIV/AIDS is no longer a nearly fatal disease, but a number of serious conditions can cause disability, even in the era of potent antiretroviral therapy. The committee suggests that a listing be developed that identifies the HIV-associated conditions currently without listings elsewhere in the Listing of Impairments.
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From page 74... ...
2010. Continued high preva lence and adverse clinical impact of human immunodeficiency virus-associated sensory neuropathy in the era of combination antiretroviral therapy: The CHARTER Study.
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From page 75... ...
. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy.
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From page 76... ...
2002. Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy.
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