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.

Keywords:

• HIV/AIDS
• highly active antiretroviral therapy
• survival rate
• mortality
• tuberculosis
• cohort studies

Acknowledgments

This was part of the M.Sc. thesis in Epidemiology. We would like to appreciate the Vice-chancellor of Education for technical support and the Vice-chancellor of Research and Technology of Hamadan University of Medical Sciences for financial support of this work. We also thank the staff and managers of the Imam Khomeini and Zamzam Behavioral Diseases Counseling Centers for their collaboration with this study.

Disclosure statement

No potential conflict of interest was reported by the authors.