Psychosocial Risk Factors of HIV Morbidity and Mortality: Findings from the Multicenter AIDS Cohort Study (MACS)

Abstract

Despite the use of laboratory markers in estimating HIV prognosis, significant variation in the natural history of HIV-1 infection remains unexplained. Recent studies suggest psychosocial risk factors have important prognostic significance in HIV disease. The objective of the present study was to examine the prognostic influence of age, general intellectual functioning, and emotional distress across the spectrum of HIV disease progression. The study sample was drawn from the Multicenter AIDS Cohort Study (MACS), a 13-year, prospective study of HIV-seropositive men recruited from four study centers across the country. The participants were 1,231 HIV-seropositive MACS participants, followed from baseline (median 8/15/87) to the end of the observation period (12/15/98). HIV disease progression was evaluated with respect to three outcome measures: (1) number of years from baseline testing to the first AIDS defining illness (progression to AIDS), (2) years from baseline to HIV-dementia (progression to dementia), and (3) years from baseline to death (survival). The influence of psychosocial risk factors on outcome measures was evaluated using survival analyses. General intellectual functioning, age, and somatic symptoms of depression, were found to be significant predictors of HIV disease progression and survival. Older age at baseline was associated with a more rapid progression to dementia and death. Lower Shipley IQ estimates were associated with a more rapid disease progression (AIDS and dementia) and shortened survival. Somatic symptoms of depression were associated with shortened survival. In addition, age, IQ, and somatic symptoms of depression, had an additive effect with an increase in the number of risk factors associated with accelerated disease progression and shortened time to death. These findings remained consistent, despite controlling for baseline CD4 and HIV medication use. Psychosocial cofactors are important in understanding HIV disease progression. Methods for estimating HIV prognosis may become more reliable if psychosocial factors are considered. Future research will clarify if psychosocial risk factors reflect central nervous system integrity, brain reserve capacity or mediate morbidity and mortality through social economic status, access to health care and other social correlates.

Socio-Demographic and Clinical Profile of People Living with HIV/AIDS.

“…A concerted counselling is required for these patients so that they can continue with the prescribed medication. Due to low level of education and poor life circumstances and associated psychological reaction high anxiety and depression [42][43][44][45][46] they run the risk of discontinuing their medication 47. A good counselling, supportive psychotherapy, and surveillance and management of toxic reaction will go a long way to help patients to continue with treatment.…”

Sadness in the SUN: Using Computerized Screening to Analyze Correlates of Depression and Adherence in HIV-Infected Adults in the United States

“…The total score could range from 0 to 27. Depression severity was defined as none/minimal (total score 0-4), mild (total score 5-9), moderate (total score [10][11][12][13][14], moderately severe (total score [15][16][17][18][19], and severe (total score [20][21][22][23][24][25][26][27], as previously reported. 43,45,46 We defined major depression as (1) a score of 2 or 3 on four of the nine items, including on each of the screener's first two items; or (2) a score of 2 or 3 on five of the nine items, including on at least one of the screener's first two items.…”

“…9,10 For these individuals, the consequences of unrecognized and untreated depression can be significant and include increased mortality, diminished quality of life, and impaired adherence to antiretroviral therapy. [11][12][13][14][15][16][17][18] A recent meta-analysis documented an association between depression and nonadherence to antiretroviral therapy across different study populations, including some that represented diverse and contemporary HIV cohorts with a significant representation of women and persons of color. 19 As the current U.S. HIV epidemic disproportionately impacts communities of color, the relationship of gender and ethnicity to depression is important to document and understand.…”

Neuropsychological impairment in racial/ethnic minorities with HIV infection and low literacy levels: Effects of education and reading level in participant characterization

“…Recently, among HIV1 gay and bisexual men IQ has been found to be a superior marker of cognitive reserve compared to education (Farinpour et al, 2003), suggesting that IQ is a better indicator of native cognitive ability. Among racial0ethnic minority elders, literacy (not education) was the most sensitive predictor of memory decline (Manly et al, 2003).…”