title: Neuropsychologic impairment in early HIV infection. A risk factor for work disability.
abstract: OBJECTIVE
  To explore the functional significance of incident neuropsychologic impairment among initially asymptomatic subjects infected with human immunodeficiency virus.
  
  
  METHODS
  Prospective, observational cohort study of homosexual and bisexual men to examine the incidence of work disability related to the onset of neuropsychologic impairment.
  
  
  METHODS
  A university clinical and behavioral research site in New York City.
  
  
  METHODS
  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.
authors.affiliation: Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Albert
authors.forename: K
authors.initials: K
authors.lastname: Marder
authors.forename: G
authors.initials: G
authors.lastname: Dooneief
authors.forename: K
authors.initials: K
authors.lastname: Bell
authors.forename: M
authors.initials: M
authors.lastname: Sano
authors.forename: G
authors.initials: G
authors.lastname: Todak
authors.forename: Y
authors.initials: Y
authors.lastname: Stern
mesh_terms: D015331:Cohort Studies; D004185:Disability Evaluation; D004651:Employment; D015658:HIV Infections / Q000503:physiopathology / Q000523:psychology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior