HIV-linked mental loss takes job toll.

Several studies conducted since 1987 indicate that perhaps one in three HIV-infected individuals who display no medical symptoms of disease nonetheless experiences mild loss of attention, memory, and reaction times on laboratory tests. Data now suggest, for the first time, that in some cases these subtle neuropsychological lapses impede day-to-day functioning, at least at work.

Symptom-free HIV-infected men more often report either unemployment or a recent drop in job performance if they also exhibit mild neuropsychological problems, assert Robert K. Heaton, a psychologist at the University of California, San Diego, School of Medicine, and his colleagues.

"It seems that the mild neuropsychological impairment often seen in HIV disease may be clinically significant," Heaton's group concludes in the January/February PSYCHOSOMATIC MEDICINE.

The findings apply to "a small subgroup of a subgroup" of currently healthy people infected with HIV, the virus that can lead to AIDS, notes Alex Martin, a psychologist at the National Institute of Mental Health in Bethesda, Md., in an accompanying comment.

Even if further studies confirm the San Diego report, Martin issues a "resounding no" to any suggestion that employers institute mandatory HIV testing to root out those whose job performance might plunge. Instead, the findings suggest that clinicians should carefully check into complaints about attention loss or other thinking problems expressed by HIV-infected people who seem otherwise healthy, he argues.

Heaton and his coworkers studied 378 men ranging in age from 18 to 50. That group consisted of 252 HIV-positive men who displayed no significant medical symptoms, 37 HIV-positive men who had immune cell irregularities and other signs of progression toward AIDS, and 89 HIV-negative controls.

Each participant completed a neuropsychological evaluation that included tests of attention, memory, language skills, spatial perception, and intelligence.

At least a mild degree of impairment on these measures emerged for half of the symptomatic HIV group, one-third of the symptom-free HIV group, and 16 percent of the controls. Neuropsychological problems of asymptomatic HIV-infected men generally peaked at mild levels. Unemployment in that group reached 22 percent, compared to 10 percent among neuropsychologically healthy HIV-positive men, according to Heaton's team. Similarly, 28 percent of employed, HIV-positive men evidencing mild neuropsychological deficits cited a marked drop in their ability to perform job duties since the detection of HIV infection; 6 percent of their unimpaired counterparts made the same complaint.

Future research must consider objective measures of job performance, such as supervisor and coworker ratings, the researchers acknowledge. Still, most men were relatively young and in the early stages of HIV infection, both of which reduce the likelihood of job difficulties. Moreover, about half the volunteers served in the military on active duty and remained employed despite their medical status.

Depression and other psychiatric disorders did not account for unemployment or job difficulties in mildly impaired HIV-positive men, the scientists note.

The initial findings of the San Diego investigation raise a number of questions, Martin contends. For instance, do work-related abilities decline most sharply in mildly impaired HIV-infected people who hold demanding jobs? Or do those who hold demanding jobs prove most capable of devising mental strategies to compensate for mild impairment?

In addition, Martin says, researchers do not know if mild neuropsychological deficits in symptom-free cases of HIV infection herald a widespread loss of thinking abilities later on.