The Detrimental Effect of Adversity on HIV Outcomes in the Era of Combined Anti-Retroviral Therapy

作     者：Corrado Cancedda Katherine S. Eddens Olumuyiwa Adebona Revathi Ravi Enbal Shacham Edgar Turner Overton 

作者机构：Department of Global Health and Social Medicine Harvard Medical School Boston USA Division of Global Health Equity Brigham and Women’s Hospital Harvard Medical School Boston USA Division of Infectious Diseases University of Alabama at Birmingham Birmingham USA George Warren Brown School of Social Work Washington University in St. Louis St. Louis USA Texas Tech University Health Sciences Center Lubbock USA 

出 版 物：《World Journal of AIDS》 (艾滋病（英文）)

年 卷 期：2012年第2卷第4期

页      面：338-346页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：HIV Outcomes Psychosocial Adversity Adherence 

摘      要：Socially disadvantaged individuals with HIV experience unacceptably high rates of AIDS and death. The authors developed an adversity index to quantify the impact of demographic and psychosocial factors on HIV care. This retrospective cohort study included 431 participants with HIV on combined antiretroviral therapy between 2000 and 2005. Poor outcome was defined as progression to AIDS, death, virologic failure, or CD4 200 cells/μl at six months. The index utilized eight demographic and psychosocial variables independently associated with poor outcome. Exposure to higher numbers of variables in the adversity index significantly increased the rates of poor outcome from 14% (exposure to no variables) to 100% (exposure to seven variables). The odds of poor outcome decreased but remained significant after adjusting for adherence-defining variables, indicating a possible mediating effect of poor adherence. Durably effective therapeutic strategies must include addressing adverse demographic and psychosocial factors affecting people living with HIV.