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Clinical predictors of declines in physical functioning in persons with AIDS: results of a longitudinal study
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
Objective:
This study was performed in an attempt to determine clinical correlates of declines in physical functioning in people with AIDS.
Design:
An 8-month longitudinal cohort study was performed at three sites in Boston, Massachusetts: a private academic group practice, an AIDS clinic at a public teaching hospital, and a staff-model health maintenance organization. Intermediate activities of daily living (IADLs), 10 symptoms and symptom complexes, mental health, and weight loss were assessed by interview in 201 persons with AIDS. Clinical diagnoses, comorbidities, laboratory results, and use of selected medications were assessed by chart review.
Results:
Participants were young (mean age, 36 years), 92% were male, 35% were nonwhite, and 27% had a history of injection drug use. The mean 8-month decrement in physical functioning was 9.6 points on a 100-point scale, and mean weight loss was 2.3 kg. After adjusting for baseline functioning, age, sex, race, and educational level, independent predictors of the 8-month IADL score included worsening fatigue (p = .0002), worsening neurologic symptoms (p = .001), weight loss (p = .0001), Candida esophagitis (p = .020), hypertension (p = .0005), depression (p = .004), and gastrointestinal (GI) disease (p = .018, model R2 = 0.56).
Conclusions:
Two symptom complexes (fatigue and neurologic symptoms), three comorbidities (hypertension, depression, and GI disease), and weight loss were significant independent predictors of 8-month IADL scores after statistically controlling for baseline IADL score and sociodemographic variables. These clinical factors are potential targets for interventions designed to improve physical functioning.