231082 Detrimental Effect of a High Adversity Score on HIV Care in the Era of Highly Active Anti-Retroviral Therapy

Wednesday, November 10, 2010

Katherine S. Eddens, MPH , School of Social Work, Health Communication Research Laboratory, Washington University, St. Louis, MO
Corrado Cancedda, MD, PhD , Department of Medicine, Infectious Diseases, Washington University School of Medicine, St. Louis, MO
Revathi Ravi , Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
E. Turner Overton, MD , Department of Medicine, Washington University School of Medicine, St. Louis, MO
Socially disadvantaged HIV+ patients in the United States experience unacceptably high rates of AIDS and death. We developed a scoring system to quantify the impact of adverse socio-economic events on HIV care. This retrospective cohort study included 431 HIV+ subjects who initiated HAART between 2000 and 2005 in a university-based Infectious Diseases clinic in St Louis, MO. Poor outcome was defined as having either clinical failure (progression to AIDS or death) or laboratory failure (VL > 400 copies/ml or CD4 <200 cells/Ál at 6 months). Seven psychosocial variables were associated with increased risk of poor outcome and used for the adversity score (male gender, non-white race, income <$0,000/year, being a single parent, cocaine abuse, depression, other psychiatric disorders). The score was categorized into quartiles determined by the cumulative number of psychosocial variables (from least to most). Rates of poor outcome were 6%, 26%, 42%, and 68% for quartile 1, 2, 3, 4 respectively. Progression to a higher quartile significantly increased odds of poor outcome (OR = 2.58, 95% CI = 1.96, 3.36). The odds of poor outcome decreased but remained significant at 2.13 (95% CI = 1.57, 2.88) after adjusting for possible mediators (poor access to care, more advanced disease at baseline, poor adherence). In our study, high adversity scores were associated with a greater likelihood of poor outcome in HIV+ patients initiating HAART. Measures targeting socioeconomic issues need to be part of a truly effective therapeutic strategy.

Learning Areas:
Clinical medicine applied in public health
Social and behavioral sciences

Learning Objectives:
Participants will be able to describe factors related to poor outcomes among individuals with HIV in medical care. Participants will identify psychosocial variables that increase adversity of outcomes.

Keywords: Access to Health Care, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted multiple health-related research studies and am working on my doctorate in social work with an emphasis in public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.