Predictors of progression to AIDS and mortality post-HIV infection: a long-term retrospective cohort study

• Published in: AIDS care 2015-10, Vol.27 (10), p.1205-1212
• Main Authors: Poorolajal, Jalal, Molaeipoor, Leila, Mohraz, Minoo, Mahjub, Hossein, Ardekani, Maryam Taghizadeh, Mirzapour, Pegah, Golchehregan, Hanieh
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - mortality; Adolescent; Adult; Age Factors; Aged; AIDS; AIDS/HIV; Antiretroviral agents; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; CD4 antigen; CD4 Lymphocyte Count; Child; Child, Preschool; Cohort analysis; Cohort Studies; Counseling; Death; Death & dying; Diagnosis; Disease Progression; Female; highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - mortality; HIV/AIDS; Human immunodeficiency virus; Humans; Immune disorders; Immune response; Infant; Infections; Iran - epidemiology; Longitudinal Studies; Male; Medical diagnosis; Medical prognosis; Middle Aged; Mortality; Multivariate analysis; Mycobacterium; Patients; Predictions; Probability; Registries; Regression analysis; Retrospective Studies; Sex; Sex Factors; Sexually transmitted diseases; Statistical analysis; STD; survival rate; Tuberculosis; Viruses; Young Adult
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540121.2015.1045405

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.