RETURN TO WORK WITH HIV/AIDS--NEUROPSYCHIATRIC FACTORS

在过去两年中，艾滋病毒/艾滋病患者的病程发生了巨大变化。随着联合抗逆转录病毒疗法的引入，特别是蛋白酶抑制剂的引入，这门课程出现了“大转弯”。许多患者的健康状况有了显著的改善，他们的免疫学特征几乎或实际上恢复了正常，随着这种改善，患者的存活时间延长，甚至有了“第二次生命”的前景。这项研究试图确定艾滋病毒/艾滋病患者的神经精神障碍和促进者，他们的健康状况现已改善，并正试图重返工作岗位。由于与医疗疾病相关的障碍已被明确认识，我们选择将重点放在确定神经认知和精神/心理社会障碍和促进者重返工作岗位上，同时考虑到医疗变量。神经精神病学变量在HIV中很重要，因为这种疾病中可测量的认知损害(在一些有症状的受试者研究中高达55%)和其他神经精神病学疾病的患病率相对较高。为了实现我们的目标，我们将招募260名HIV+受试者进入一个非营利性机构(多任务服务，MTS)，该机构旨在帮助希望重返工作岗位的艾滋病毒感染者。我们将在这个项目中对这些人进行为期两年的跟踪。将获得神经心理、精神和心理社会功能的基线测量，并每隔六个月重复一次，在这些半年度访问之间进行三个月的电话联系，以确定受试者的健康、精神和/或就业状况的任何变化。这将使我们能够确定入职时和研究期间的神经精神变量与最终找到和维持工作的成功或困难之间的关系。有了这些数据，我们将确定哪些神经精神因素(认知、精神和心理社会)在寻求重返工作的HIV+个人中充当障碍或促进器。我们还将研究某些类型的神经心理障碍是否对不同职业类别的重返工作构成特殊障碍。

The course of illness for persons with HIV/AIDS has changed dramatically in the last two years. With the introduction of combination antiretroviral therapy, and specifically, protease inhibitors, this course has taken an "about face." The health of many patients has significantly improved, their immunologic profile nearly or actually normalized, and with this improvement has come the prospect of extended survival and even a "second life." This study seeks to identify neuropsychiatric barriers and facilitators for persons with HIV/AIDS whose health has now improved and are attempting to return to work. Since barriers associated with medical illness are clearly recognized, we have chosen to focus on defining neurocognitive and psychiatric/psychosocial barriers and facilitators to return to work, while taking medical variables into account. Neuropsychiatric variables are important in HIV because of the relatively high prevalence of measurable cognitive impairment (up to 55% in some studies of symptomatic subjects) and other neuropsychiatric conditions in this illness. To accomplish our aims, we will enroll a group of 260 HIV+ subjects entering a non-profit agency (Multi-Tasking Service, MTS) designed to assist persons with HIV infection who wish to return to work. We will follow these individuals in this program for a period of two years. Baseline measures of neuropsychological, psychiatric and psychosocial function will be obtained, and repeated at six month intervals with three month telephone contact in between these semi- annual visits in order to identify any change in subjects' health, psychiatric and/or employment status. This will allow us to determine the relationship between neuropsychiatric variables at entry as well as during the study period and eventual success or difficulty in finding and maintaining employment. With these data, we will determine which neuropsychiatric factors (cognitive, psychiatric, and psychosocial) serve as barriers or facilitators for return to work in HIV+ individuals seeking to return to work. We will also examine whether certain patterns of neuropsychological difficulties pose particular barriers to return to work for various occupational categories.