RETURN TO WORK WITH HIV/AIDS: NEUROPSYCHIATRIC FACTORS

艾滋病毒/艾滋病患者的病程在过去两年中发生了巨大变化。随着抗逆转录病毒联合疗法，特别是蛋白酶抑制剂的引入，这一过程发生了“大转变”。许多患者的健康状况得到了显著改善，他们的免疫状况接近或实际上恢复了正常，这种改善带来了延长生存期甚至“第二次生命”的前景。这项研究旨在确定艾滋病毒/艾滋病患者的神经精神障碍和促进因素，这些人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得到明确认识，我们选择将重点放在确定神经认知和精神/社会心理障碍以及重返工作岗位的促进因素上，同时考虑到医疗变量。神经精神变量在艾滋病毒中很重要，因为这种疾病中可测量的认知障碍（在一些有症状的受试者中高达55%）和其他神经精神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阳性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HIV感染者。我们将对这些人进行为期两年的跟踪调查。将获得神经心理学、精神病学和社会心理功能的基线测量，并每隔六个月重复一次，每隔半年进行一次电话联系，以确定受试者的健康、精神病学和/或就业状况的任何变化。这将使我们能够确定入职时以及学习期间的神经精神变量与最终成功或困难找到和维持就业之间的关系。有了这些数据，我们将确定哪些神经精神因素（认知、精神和社会心理）成为寻求重返工作岗位的HIV+个体重返工作岗位的障碍或促进因素。我们还将研究某些类型的神经心理障碍是否会对各种职业类别的重返工作造成特别的障碍。

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.