Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort.

TitlePredictors of AIDS-related morbidity and mortality in a southern U.S. Cohort.
Publication TypeJournal Article
Year of Publication2007
AuthorsMugavero MJ, Pence BWells, Whetten K, Leserman J, Swartz M, Stangl D, Thielman NM
JournalAIDS Patient Care STDS
Volume21
Issue9
Pagination681-90
Date Published2007 Sep
ISSN1087-2914
KeywordsAcquired Immunodeficiency Syndrome, Adult, Aged, AIDS-Related Opportunistic Infections, Cohort Studies, Female, Humans, Incidence, Male, Middle Aged, Proportional Hazards Models, Psychosocial Deprivation, Southeastern United States, Survival Analysis
Abstract

Advances in the treatment of HIV and associated opportunistic infections (OIs) have led to dramatic reductions in HIV-related morbidity and mortality in the United States, but not all patients have benefited equally. A longitudinal analysis of the Coping with HIV/AIDS in the Southeast (CHASE) cohort evaluated sociodemographic, psychosocial, and clinical factors associated with HIV-related events (incident category C OI or AIDS-related death) among southern HIV-infected patients engaged in clinical care. Participants were followed for a median of 30 months (interquartile range, 17-34 months) after study enrollment (enrollment period December 2001 to April 2002). Ten percent of study participants (50/489) experienced an HIV-related event (incident category C OI and/or AIDS-related deaths) during study follow-up. The rate of HIV-related events was 4.8 per 100 patient-years of observation, and the rate of AIDS-related death was 1.5 per 100 patient-years of observation. In unadjusted survival analyses, younger age, lacking private health insurance, psychosocial trauma, depressive symptoms, lower baseline CD4 count, and less time on antiretroviral therapy during follow-up were associated with HIV-related events. In Cox proportional hazards analysis adjusting for covariates, patients who had suffered more psychosocial trauma (hazard ratio [HR] = 1.97, p = 0.04), who had lower baseline CD4 counts (HR = 0.48 per 100 cells/mm(3), p < 0.01), and who spent less time on antiretroviral therapy during follow-up (HR = 0.47, p = 0.02) were more likely to experience an HIV-related event.

DOI10.1089/apc.2006.0167
Alternate JournalAIDS Patient Care STDS
PubMed ID17919095
Grant List5R01MH061687-05 / MH / NIMH NIH HHS / United States
T32 HS000079 / HS / AHRQ HHS / United States
V01AI-069484 / AI / NIAID NIH HHS / United States