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A Journal on Forensic Medicine
Minerva Medicolegale 2003 March;123(1):1-19
The evaluation of disability in HIV infection. Medico-legal considerations regarding new clinical aspects
Urso R., Fatigante G., Niutta P.
A reflection is proposed on the need to adapt the medico-legal evaluation of HIV-induced invalidity to the modifications that have occurred in recent years in the clinical history and prognosis of the disease. The judgement on HIV-induced invalidity must take account of the benefits brought to the life of the patient by the new treatments. The CDC classification does not allow us to automatically make direct comparisons between the status of the patient and his real degree of invalidity as it is geared prevalently to epidemiological studies and does not have a real dynamic character as regards the clinical aspect. Every medico-legal judgement must therefore be specifically adapted to the peculuarities of the individual case. Evaluation of the clinical and viro-immunological parameters of the ongoing therapies and of the side-effects, the application of the Karnofsky scale and knowledge of the subject's working activity is necessary. The introduction of the new treatments has brought important ploblems to the surface. These include difficulties of compliance, side-effects on the glucolipidic metabolism and organ toxicity. Paradoxically the therapy, albeit effective, is at times associated with disturbances which lead to the suspension of the drugs. After a broad examination of all those elements of clinical medicine and therapy of interest to the legal physician, the authors suggest the criteria for a correct methodology which should be borne in mind in the evaluation process of the invalidity.