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Predicting death over 8 years in a prospective cohort of HIV-infected women: the Women’s Interagency HIV Study.

Predicting death over 8 years in a prospective cohort of HIV-infected women: the Women’s Interagency HIV Study.
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Gustafson DR, Shi Q, Holman S, Minkoff H, Cohen MH, Plankey MW, Havlik R, Sharma A, Gange S, Gandhi M, Milam J, Hoover DR,


Gustafson DR, Shi Q, Holman S, Minkoff H, Cohen MH, Plankey MW, Havlik R, Sharma A, Gange S, Gandhi M, Milam J, Hoover DR, (click to view)

Gustafson DR, Shi Q, Holman S, Minkoff H, Cohen MH, Plankey MW, Havlik R, Sharma A, Gange S, Gandhi M, Milam J, Hoover DR,

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BMJ open 2017 06 307(6) e013993 doi 10.1136/bmjopen-2016-013993

Abstract
OBJECTIVES
Predicting mortality in middle-aged HIV-infected (HIV+) women on antiretroviral therapies (ART) is important for understanding the impact of HIV infection. Several health indices have been used to predict mortality in women with HIV infection. We evaluated: (1) an HIV biological index, Veterans Aging Cohort Study (VACS); (2) a physical index, Fried Frailty Index (FFI); and (3) a mental health index, Center for Epidemiologic Studies-Depression (CES-D). Proportional hazards regression analyses were used to predict death and included relevant covariates.

DESIGN
Prospective, observational cohort.

SETTING
Multicentre, across six sites in the USA.

PARTICIPANTS
1385 multirace/ethnic ART-experienced HIV+ women in 2005.

PRIMARY AND SECONDARY OUTCOMES
All deaths, AIDS deaths and non-AIDS deaths up to ~8 years from baseline.

RESULTS
Included together in one model, VACS Index was the dominant, significant independent predictor of all deaths within 3 years (HR=2.20, 95% CI 1.83, 2.65, χ(2)=69.04, p<0.0001), and later than 3 years (HR=1.55, 95% CI 1.30, 1.84, χ(2)=23.88, p<0.0001); followed by FFI within 3 years (HR=2.06, 95% CI 1.19, 3.57, χ(2)=6.73, p=0.01) and later than 3 years (HR=2.43, 95% CI 1.58, 3.75, χ(2)=16.18, p=0.0001). CES-D score was not independently associated with mortality. CONCLUSIONS AND RELEVANCE
This is the first simultaneous evaluation of three common health indices in HIV+ adults. Indices reflecting physical and biological ageing were associated with death.

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