title: Predictors of progression to AIDS and mortality post-HIV infection: a long-term retrospective cohort study.
abstract: This study was conducted to better understand the prognostic factors influencing the disease progression and mortality in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in a high-middle-income country. This registry-based retrospective cohort study was conducted in Tehran from April 2004 to March 2014. We enrolled 2473 HIV-infected patients who had a medical record in Behavioral Diseases Counseling Centers. The outcomes of interest were the estimation of time: (1) from HIV diagnosis to AIDS progression and (2) from AIDS to AIDS-related death. The 1-year, 5-year, and 10-year probability of disease progression from HIV diagnosis to AIDS was 45.0%, 69.9%, and 90.4%, and that of AIDS-related death was 17.2%, 30.3%, and 39.2%, respectively. Multivariate Cox regression analysis indicated that AIDS progression was significantly associated with male sex (P = 0.022), an increase in age (P = 0.001), low educational levels (P = 0.001), and a decreased level of CD4 cell count (P = 0.001). Furthermore, the AIDS-related mortality was significantly associated with male sex (P = 0.010), tuberculosis coinfection (P = 0.001), and antiretroviral therapy (P = 0.001). The results of this study indicated that progression to AIDS and AIDS-related death is affected by several modifiable and non-modifiable predictors. We indicated that a substantial proportion of the HIV-positive people were unaware of their status and were diagnosed very late. This hidden source of HIV infection had the opportunity to transmit the infection to other people.
authors.affiliation: a Research Center for Health Sciences and Department of Epidemiology , School of Public Health, Hamadan University of Medical Sciences , Hamadan , Iran.
authors.forename: Jalal
authors.initials: J
authors.lastname: Poorolajal
authors.affiliation: b Department of Epidemiology , School of Public Health, Hamadan University of Medical Sciences , Hamadan , Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Molaeipoor
authors.affiliation: c Iranian Research Center for HIV/AIDS , Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Science , Tehran , Iran.
authors.forename: Minoo
authors.initials: M
authors.lastname: Mohraz
authors.affiliation: a Research Center for Health Sciences and Department of Epidemiology , School of Public Health, Hamadan University of Medical Sciences , Hamadan , Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mahjub
authors.affiliation: d Medical Health Center , Tehran University of Medical Science , Tehran , Iran.
authors.forename: Maryam Taghizadeh
authors.initials: MT
authors.lastname: Ardekani
authors.affiliation: e Iranian Research Center for HIV/AIDS , Ministry of Health and Medical Education , Tehran , Iran.
authors.forename: Pegah
authors.initials: P
authors.lastname: Mirzapour
authors.affiliation: e Iranian Research Center for HIV/AIDS , Ministry of Health and Medical Education , Tehran , Iran.
authors.forename: Hanieh
authors.initials: H
authors.lastname: Golchehregan
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult
keywords: HIV/AIDS; cohort studies; highly active antiretroviral therapy; mortality; survival rate; tuberculosis