Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia

Abstract

In order to achieve the programmatic goals established in the National HIV/AIDS Strategy, virologic suppression remains the most important outcome within the HIV care continuum for individuals receiving antiretroviral therapy (ART). Therefore, clinicians have dedicated substantial resources to improve adherence and clinic retention for individuals on ART; however, these efforts should be focused first on those most at risk of morbidity and mortality related to AIDS. Our study aimed to characterize the factors that are associated with AIDS-defining illnesses (ADIs) amongst people living with HIV (PLHIV) who are poorly adherent or retained in care in order to identify those at highest risk of poor clinical outcomes. We recruited 99 adult PLHIV with a history of poor adherence to ART, poor clinic attendance, or unsuppressed viral load (VL) from the Infectious Disease Program (IDP) of the Grady Health System in Atlanta, Georgia between January and May 2011 to participate in a survey investigating the acceptability of a financial incentive for improving adherence. Clinical outcomes including the number of ADI episodes in the last five years, VLs, and CD4 counts were abstracted from medical records. Associations between survey items and number of ADIs were performed using chi-square analysis. In our study, 36.4% of participants had ≥1 ADI in the last five years. The most common ADIs were Pneumocystis jirovecii pneumonia, recurrent bacterial pneumonia, and esophageal candidiasis. Age <42.5 years (OR 2.52, 95% CI = 1.08–5.86), male gender (OR 3.51, 95% CI = 1.08–11.34), CD4 nadir <200 cells/µL (OR 11.92, 95% CI = 1.51–94.15), unemployment (OR 3.54, 95% CI = 1.20–10.40), and travel time to clinic <30 minutes (OR 2.80, 95% CI = 1.20–6.52) were all significantly associated with a history of ≥1 ADI in the last five years. Awareness of factors associated with ADIs may help clinicians identify which poorly adherent PLHIV are at highest risk of HIV-related morbidity.

Keywords:

• AIDS-defining illness
• opportunistic infection
• HIV adherence

Acknowledgments

The authors would like to acknowledge the efforts by Elyse LaFond and Chris Foster in recruiting patients, chart abstraction, and administering the study. We would also like to thank the patients of the Infectious Disease Program of the Grady Health System for their participation in this study. Their involvement has enabled us to enhance the care of other people living with HIV.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institutes of Health [grant number P30AG034532] and was facilitated by the Center for AIDS Research at Emory University [grant number P30AI050409].