We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Non-AIDS complexity amongst patients living with HIV in Sydney: risk factors and health outcomes.
- Authors
Chan, Derek J.; Furner, Virginia; Smith, Don E.; Dronavalli, Mithilesh; Bopage, Rohan I.; Post, Jeffrey J.; Bhardwaj, Anjali K.
- Abstract
Objective: To assess the prevalence of non-AIDS co-morbidities (NACs) and predictors of adverse health outcomes amongst people living with HIV in order to identify health needs and potential gaps in patient management. Design: Retrospective, non-consecutive medical record audit of patients attending a publicly funded HIV clinic in metropolitan Sydney analysed for predictors of adverse health outcomes. We developed a scoring system based on the validated Charlson score method for NACs, mental health and social issues and confounders were selected using directed acyclic graph theory under the principles of causal inference. Results: 211 patient files were audited non-consecutively over 6 weeks. 89.5% were male; 41.8% culturally and linguistically diverse and 4.1% were of Aboriginal/Torres Strait Islander origin. Half of patients had no general practitioner and 25% were ineligible for Medicare subsidised care. The most common NACs were: cardiovascular disease (25%), hepatic disease (21%), and endocrinopathies (20%). One-third of patients had clinical anxiety, one-third major depression and almost half of patients had a lifetime history of tobacco smoking. Five predictors of poor health outcomes were identified: (1) <italic>co</italic>-<italic>morbidity score</italic> was associated with hospitalisation (odds ratio, OR 1.58; 95% CI 1.01–2.46; <italic>p</italic> = 0.044); (2) <italic>mental health score</italic> was associated with hospitalisation (OR 1.79; 95% CI 1.22–2.62; <italic>p</italic> = 0.003) and poor adherence to ART (OR 2.34; 95% CI 1.52–3.59; <italic>p </italic>= 0.001); (3) <italic>social issues score</italic> was associated with genotypic resistance (OR 2.61; 95% CI 1.48–4.59; <italic>p </italic>= 0.001), co-morbidity score (OR 1.69; 95% CI 1.24–2.3; <italic>p </italic>= 0.001) and hospitalisation (OR 1.72; 95% CI 1.1–2.7; <italic>p </italic>= 0.018); (4) <italic>body mass index</italic> < 20 was associated with genotypic resistance (OR 6.25; 95% CI 1.49–26.24; <italic>p</italic> = 0.012); and (5) <italic>Medicare eligibility</italic> was associated with co-morbidity score (OR 2.21; 95% CI 1.24–3.95; <italic>p</italic> = 0.007). Conclusion: Most HIV patients are healthy due to effective antiretroviral therapy; however, NACs and social/mental health issues are adding to patient complexity. The current findings underpin the need for multidisciplinary management beyond routine viral load and CD4 count monitoring.
- Subjects
AUSTRALIA; ANTIRETROVIRAL agents; HOSPITALS; AIDS; AUDITING; CARDIOVASCULAR diseases; CONFIDENCE intervals; MENTAL depression; ENDOCRINE diseases; HIV infections; HIV-positive persons; HOSPITAL care; LIVER diseases; MEDICARE; MENTAL health; NEEDS assessment; COMORBIDITY; VIRAL load; DISEASE prevalence; RETROSPECTIVE studies; ADVERSE health care events; CD4 lymphocyte count; ODDS ratio
- Publication
AIDS Research & Therapy, 2018, Vol 15, p1
- ISSN
1742-6405
- Publication type
Article
- DOI
10.1186/s12981-018-0193-z