title: Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort.
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.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Brian Wells
authors.initials: BW
authors.lastname: Pence
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.forename: Jane
authors.initials: J
authors.lastname: Leserman
authors.forename: Marvin
authors.initials: M
authors.lastname: Swartz
authors.forename: Dalene
authors.initials: D
authors.lastname: Stangl
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011610:Psychosocial Deprivation; D015144:Southeastern United States / Q000453:epidemiology; D016019:Survival Analysis