title: Poverty, hunger, education, and residential status impact survival in HIV.
abstract: Despite combination antiretroviral therapy (ART), HIV infected people have higher mortality than non-infected. Lower socioeconomic status (SES) predicts higher mortality in many chronic illnesses but data in people with HIV is limited. We evaluated 878 HIV infected individuals followed from 1995 to 2005. Cox proportional hazards for all-cause mortality were estimated for SES measures and other factors. Mixed effects analyses examined how SES impacts factors predicting death. The 200 who died were older, had lower CD4 counts, and higher viral loads (VL). Age, transmission category, education, albumin, CD4 counts, VL, hunger, and poverty predicted death in univariate analyses; age, CD4 counts, albumin, VL, and poverty in the multivariable model. Mixed models showed associations between (1) CD4 counts with education and hunger; (2) albumin with education, homelessness, and poverty; and (3) VL with education and hunger. SES contributes to mortality in HIV infected persons directly and indirectly, and should be a target of health policy in this population.
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA. jmcmahon@tuftsmedicalcenter.org
authors.forename: James
authors.initials: J
authors.lastname: McMahon
authors.forename: Christine
authors.initials: C
authors.lastname: Wanke
authors.forename: Norma
authors.initials: N
authors.lastname: Terrin
authors.forename: Sally
authors.initials: S
authors.lastname: Skinner
authors.forename: Tamsin
authors.initials: T
authors.lastname: Knox
mesh_terms: D000367:Age Factors; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D006815:Hunger; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics; D012237:Rhode Island / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents