Neuropsychologic impairment in early HIV infection. A risk factor for work disability
S. M. Albert, K. Marder, G. Dooneief, K. Bell, M. Sano, G. Todak and Y. Stern
Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, USA.
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 (> or = 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.
