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A Risk Factor for Work Disability

Steven M. Albert, PhD; Karen Marder, MD, MPH; George Dooneief, MD, MPH; Karen Bell, MD; Mary Sano, PhD; George Todak, MSW; Yaakov Stern, PhD

Arch Neurol. 1995;52(5):525-530.

Abstract
Objective
To explore the functional significance of incident neuropsychologic impairment among initially asymptomatic subjects infected with human immunodeficiency virus.

Design
Prospective, observational cohort study of homosexual and bisexual men to examine the incidence of work disability related to the onset of neuropsychologic impairment.

Setting
A university clinical and behavioral research site in New York City.

Participants
Sample of 207 homosexual and bisexual men; 123 were seropositive and 84 were seronegative.

Principal Outcome Measures
Incident work disability in the course of 4.5 years of follow-up, with disability defined as a persistent (24 months) change in work hours (from 20 or more to less than 20 h/wk).

Results
Compared with seronegative control subjects (n=72), the relative risk of work disability among initially asymptomatic seropositive men (n=44) was 2.76 (95% confidence interval, 1.2 to 6.5), nearly a threefold increase. Proportional hazards models show that this increased risk is attributable to the development of major neuropsychologic impairment in a subset (eight of 44) of the initially asymptomatic men, which is significantly associated with incident work disability (6/8 [75%]). Adjusting for symptom status and CD4⁺ cell count at the time of disability did not eliminate the increased risk associated with neuropsychologic impairment.

Conclusions
In this cohort, the increased risk of work disability among initially asymptomatic human immunodeficiency virus—positive men was related to incident neuropsychologic impairment; such impairment predicted work disability independently of symptom status and CD4⁺ cell count over the follow-up period. Neuropsychologic impairment in the course of human immunodeficiency virus infection may indicate increased risk for poor outcomes over and above that associated with systemic disease.

Author Affiliations
From the Gertrude H. Sergievsky Center and Departments of Neurology (Drs Albert, Marder, Dooneief, Bell, and Sano) and Psychiatry (Dr Stern), College of Physicians and Surgeons, Columbia University, and the HIV Center for Clinical and Behavioral Research, New York State Psychiatric Institute (Mr Todak and Dr Stern), New York.

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