NEUROPSYCHOLOGICAL IMPAIRMENT IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - IMPLICATIONS FOR EMPLOYMENT

Individuals infected with the human immunodeficiency virus-Type 1 (HIV -1), are at increased risk for neurobehavioral impairment, particularl y in later stages of the disease. Even patients in the medically asymp tomatic or minimally symptomatic stages of infection may show mild def icits on comprehensive neuropsychological (NP) test batteries, althoug h the clinical significance of such deficits remains uncertain. The pr esent study used vocational difficulties as markers of clinical signif icance of NP impairment. In a sample of 289 HIV-infected, nondemented men, those who evidenced NP impairment had a higher unemployment rate (p <.001) than did their unimpaired counterparts. In HIV-positive subj ects who remained employed, NP impairment was strongly associated with subjective decreases in job-related abilities. Neither depression nor medical symptoms could explain the relationship between the NP impair ment and employment problems. These results are consistent with previo us studies investigating other neuropsychiatric disorders, which sugge st that even mild NP impairment can interfere with employment status. From this standpoint, such impairment in HIV-infected persons may be d escribed as ''clinically significant.''