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Poverty, Hunger, Education, and Residential Status Impact Survival in HIV

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Abstract

Despite combination antiretroviral therapy (ART), HIV infected people have higher mortality than non-infected. Lower socioeconomic status (SES) predicts higher mortality in many chronic illnesses but data in people with HIV is limited. We evaluated 878 HIV infected individuals followed from 1995 to 2005. Cox proportional hazards for all-cause mortality were estimated for SES measures and other factors. Mixed effects analyses examined how SES impacts factors predicting death. The 200 who died were older, had lower CD4 counts, and higher viral loads (VL). Age, transmission category, education, albumin, CD4 counts, VL, hunger, and poverty predicted death in univariate analyses; age, CD4 counts, albumin, VL, and poverty in the multivariable model. Mixed models showed associations between (1) CD4 counts with education and hunger; (2) albumin with education, homelessness, and poverty; and (3) VL with education and hunger. SES contributes to mortality in HIV infected persons directly and indirectly, and should be a target of health policy in this population.

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Acknowledgments

We wish to thank the participants and investigators of the Nutrition for Healthy Living cohort for their time and enthusiasm.

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Authors and Affiliations

  1. Department of Medicine, Tufts Medical Center, Boston, MA, 02111, USA

    James McMahon, Christine Wanke & Tamsin Knox

  2. Nutrition/Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, Jaharis 276, 150 Harrison Avenue, Boston, MA, 02111, USA

    James McMahon, Christine Wanke, Sally Skinner & Tamsin Knox

  3. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    Norma Terrin

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  1. James McMahon
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Correspondence to James McMahon.

Additional information

Supported by the National Institutes of Health grants R01 HL 65947, P30 DA13868, P30 AI42853, and P01 DK45734.

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McMahon, J., Wanke, C., Terrin, N. et al. Poverty, Hunger, Education, and Residential Status Impact Survival in HIV. AIDS Behav 15, 1503–1511 (2011). https://doi.org/10.1007/s10461-010-9759-z

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