Comment from Fete, C. Louis, Florida DDS

We recommend that following improvements be considered for augmentation of the current 14.08/114.08 listings. These comments refer to Docket No. SSA-2007- 0082. While the current listings are sufficient to properly assess the majority of claims relating to allegations of HIV, the Florida DDS believes that the following suggestions will not only add clarification but will also greatly improve the adjudicative team’s ability to make efficient, accurate and compassionate determinations. PROPOSED CHANGES FOR REVISED MEDICAL CRITERIA FOR EVALUATING IMMUNE SYSTEM DISORDERS AS PRINTED IN THE FINAL RULES ISSUED ON 3/18/2008. Federal Register Page 14602 • 14.00C.5 CHANGE: “Extra- articular means “other than the joints”; for example an organ(s) such as the heart lungs, kidneys, or skin” TO: “Extra- articular means “other than the joints”; for example an organ(s) such as the heart lungs, kidneys, skin or eyes.” Federal Register Page 14604 • 14.00F.3.b.(i) CHANGE: “Supportive evidence may include: fever, dyspnea, hypoxia, CD4 count below 200, and no evidence of bacterial pneumonia.” TO: “Supportive evidence may include: fever, progressive exertional dyspnea, tachypnea, tachycardia, nonproductive cough, chest discomfort, weight loss, chills, hemoptysis, hypoxemia with an increased alveolar-arterial oxygen gradient, respiratory alkalosis, impaired diffusing capacity, increased serum LDH level, CD4 count below 200, and no evidence of bacterial or viral pneumonia.” CHANGE: “Also supportive are bilateral lung interstitial infiltrates on x-ray, a typical pattern on CAT scan, or a gallium scan positive for pulmonary uptake.” TO: “Also supportive are bilateral interstitial lung infiltrates with ‘ground-glass’ and/or honeycombing appearance on x-ray, a typical pattern on CAT scan, or a gallium scan positive for pulmonary uptake.” PROPOSED CHANGES FOR LISTING 14.08 AS REQUESTED IN THE ANPRM FOR THE 14.08 LISTING LISTING 14.08A. Bacterial infections: ADD: “Shigella bacteremia, recurrent or resistant to treatment” ADD: “Bartonellosis, recurrent or resistant to treatment” ADD: “Shigellosis (bacillary dysentery), resistant to treatment” ADD: “Salmonellosis, resistant to treatment” ADD: “Campylobacteriosis, resistant to treatment” ADD: “Legionellosis, resistant to treatment” ADD: “Listeriosis, at a site other than the GI tract or lymph nodes” ADD: “Clostridium difficile colitis, resistant to treatment” ADD: “Bacillary angiomatosis” NOTE: Bacillary angiomatosis is the vascular proliferative form of Bartonella infection and is an AIDS-defining disease. LISTING 14.08A.3. CHANGE: “Salmonella bacteremia, recurrent non-typhoid” TO: “Non-typhoid salmonella bacteremia, recurrent or resistant to treatment” LISTING 14.08B.2. CHANGE: “…..oral or vulvovaginal mucous membranes” TO: “…..oropharyngeal or vulvovaginal mucous membranes” LISTING 14.08B.7. CHANGE: “Pneumocystis pneumonia or extrapulmonary Pneumocystis infection” TO: “Pneumocystis pneumonia, resistant to treatment, or extrapulmonary Pneumocystis Infection (for example, Pneumocystis choroidopathy)” LISTING 14.08C. Protozoan or helminthic infections: ADD: “Amebiasis, resistant to treatment” ADD: “Giardiasis, resistant to treatment” ADD: “Visceral, cutaneous, or mucocutaneous leishmaniasis” ADD: “Schistosomiasis” ADD: “Opisthorchiasis” ADD: “Ancylostomiasis, extra-intestinal (for example, cutaneous larva migrans)” ADD: “Angiostrongyliasis, extra-intestinal (for example, cerebral angiostrongyliasis)” ADD: “Echinococcosis” ADD: “Cysticercosis, extra-intestinal (for example, visceral cysticercosis or neurocysticercosis)” ADD: “Trichinellosis, extra-intestinal (for example, systemic trichinellosis or neurotrichinellosis)” ADD: “Toxocariasis, extra-intestinal (for example, visceral larva migrans or ocular larva migrans)” ADD: “Malaria, resistant to treatment” LISTING 14.08C.1. CHANGE: “Cryptosporidiosis, isosporiasis, or microsporidiosis, with diarrhea lasting for 1 month or longer” TO: “Cryptosporidiosis, isosporiasis, microsporidiosis, or cyclosporiasis, with diarrhea lasting for 1 month or longer or diarrhea resistant to treatment” LISTING 14.08C.2. CHANGE: “Strongyloidiasis, extra-intestinal” TO: “Strongyloidiasis, extra-intestinal or Strongyloidiasis, resistant to treatment” LISTING 14.08C.3. CHANGE: “Toxoplasmosis of an organ other than the liver, spleen, or lymph nodes” TO: “Toxoplasmosis at a site other than the liver, spleen, or lymph nodes (for example, Toxoplasma retinitis)” LISTING 14.08D. ADD: “Molluscum contagiosum, mucocutaneous infection (for example, oral, genital, perianal, periocular, conjunctival) lasting for 1 month or longer” LISTING 14.08D.3. Herpes zoster: ADD: “Herpes zoster ophthalmicus, resistant to treatment” LISTING 14.08E. Malignant neoplasms 14.08E.1. NOTE: Invasive squamous cell carcinoma of the vulva is most often caused by HPV and occurs more commonly in HIV-infected people. ADD: “Ebstein-Barr virus-associated smooth muscle tumor, persistent or recurrent following initial antineoplastic therapy” LISTING 14.08F. CHANGE: “… (for example, dermatological conditions such as eczema or psoriasis…” TO: “… (for example, dermatological conditions such as eczema, psoriasis, seborrheic dermatitis, or eosinophilic folliculitis…” CHANGE: “…..vulvovaginal or other mucosal Candida, condyloma caused by human Papillomavirus, genital ulcerative disease” TO: “…..oropharyngeal, vulvovaginal, perianal, or other mucosal Candida, necrotizing ulcerative gingivitis, condyloma caused by human Papillomavirus, or genital ulcerative disease” LISTING 14.08G. CHANGE: “HIV encephalopathy, characterized by cognitive or motor dysfunction that limits function and progresses.” TO: “HIV encephalopathy or AIDS dementia complex, characterized by cognitive, motor, or behavioral dysfunction or psychomotor retardation that limits function and progresses.” LISTING 14.08J.3. CHANGE: “Pneumonia” TO: “Pneumonia (for example, bacterial, viral, fungal, or Pneumocystis pneumonia)” LISTING 14.08K. CHANGE: “…..or other manifestations (for example, oral hairy leukoplakia, myositis, pancreatitis, hepatitis, peripheral neuropathy, glucose intolerance, muscle weakness, cognitive or other mental limitation)…..” TO: “…..or other manifestations (for example, oral hairy leukoplakia, aphthous ulcerations, glucose intolerance, polymyositis, inclusion body myositis, rhabdomyolysis, pancreatitis, hepatitis, malabsorption syndrome, protein-calorie malnutrition, HIV lipodystrophy/HIV-associated adipose redistribution syndrome, HIV-associated peripheral neuropathy, axonal atrophy, muscle weakness, HIV myopathy, nemaline rod myopathy, HIV-associated enteropathy, HIV retinopathy, multisystem involvement, persistent generalized lymphadenopathy, cognitive or other mental limitation)…..” We appreciate the opportunity to recommend improvements to the current HIV listings. Should you have any further questions or need additional information, please feel free to contact our office. Specific questions may be directed to Andy Messer, Health Program Analyst at 850-487-1491, extension 247 or via email at andrew.messer@ssa.gov.