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，这门课程已经发生了“改变”。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正常化，随着这种改善，生存期延长甚至“第二次生命“的前景也随之而来。“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，这些患者的健康状况现已得到改善，并正试图重返工作岗位。由于与医学疾病相关的障碍是明确认识到的，我们选择专注于定义神经认知和精神/心理障碍和促进重返工作岗位，同时考虑到医疗变量。神经精神变量在HIV中很重要，因为可测量的认知障碍（在一些有症状受试者的研究中高达55%）和其他神经精神疾病在这种疾病中的患病率相对较高。为了实现我们的目标，我们将招募一组260名HIV阳性受试者进入一个非营利机构（多任务服务，MTS），旨在帮助希望重返工作岗位的HIV感染者。我们将在这个项目中跟踪这些人两年。将获得神经心理学、精神病学和心理社会功能的基线测量值，并每隔6个月重复一次，在这些半年一次的访视之间进行3个月的电话联系，以确定受试者的健康、精神病学和/或就业状态的任何变化。这将使我们能够确定神经精神变量之间的关系，以及在研究期间，最终成功或难以找到和维持就业。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）作为障碍或促进返回工作的HIV+个人寻求返回工作。我们还将研究是否某些模式的神经心理困难构成特殊的障碍，以返回工作的各种职业类别。

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.