Function Limitation, HIV Infection, and Mortality in AIDS Linked to the IntraVenous Experience (ALIVE) Study
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Date
2014-04-25
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Johns Hopkins University
Abstract
As the results of HARRT, HIV has developed into a chronic disease where the incidence of age-associated disorder is rising. Functional limitation is reported to be associated with multiple adverse conditions in elderly HIV-infected individual. However, few studies have been conducted on health related quality of life, especially the effects of physical limitation on mortality in an HIV setting. The objectives of our study are to identify the correlates of functional limitation and the impact of functional limitation on mortality in a cohort of aging injection drug users (IDUs).
Functional limitation is ascertained as reporting “limited a lot” with any of the 6 physical activity questions contained in MOS-HIV and SF-12 questionnaires. Our study population contain 1854 participates from ALIVE Study recruited in 1988-1989, 1994-1995, 1998, 2000, and 2005-2008. GEE-logistic model is performed to assess the marginal effect of covariates on self-reported functional limitation. Kaplan-Meier survival analyses and Cox proportional hazards regression models were conducted to evaluate the impact of functional limitation on mortality.
208 deaths were observed in 1854 patients during a period of 6 years. The prevalence of functional limitation is 28% and HIV infected is 30%. In the multivariable model HIV infection is associated with an increased likelihood of being functional limited (OR, 1.20; 95% CI, 1.03–1.39). The association is stronger in person with advanced HIV disease (CD4 cell counts less than 350 cells/uL as well as detected viral load). Gender, age, education, number of comorbidity conditions and self-rated bodily pain and general health status is significantly correlated to functional
limitations. In survival analysis, functional limitation independently is associated with a dramatic decline (HR, 1.64; 95% CI, 1.25–2.16), in survival rate. But the effect is mediated by other variables such as sociodemographic factors, such as HIV status and comorbidity conditions (adjusted HR, 1.26; 95% CI, 0.93–1.71).
From the study we can conclude that HIV infection is associated with increased risk of functional limitation in IDUs populations. Individuals with advanced HIV disease have the highest risk of developing functional limitation. Functional limitation alone is associated with mortality, while the effect is mediated by other covariates.
This thesis is original, unpublished, independent work by the author, Hao Ying, under the supervision of Professor Greg D Kirk.
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Keywords
Functional limitation, Mortality, HIV Infection