Retention in care and survival rates in comorbid conditions in persons living with HIV

Date

2017-05

Authors

Park, Jungmin

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Abstract

More than one million people suffer from human immunodeficiency virus (HIV) infections in the United States. Recently, HIV treatments have been developing and improving steadily. Seeing this, persons living with HIV (PLWH) now live longer, but they can also have more chances to experience comorbid conditions. As a result, this dissertation study has two aims. Aim 1 is a longitudinal retrospective cross-sectional study to investigate the relationships of retention in care measurements, association with symptom burden and retention in care, and association between disease control and retention in care between PLWH with diabetes (DM). Aim 2 is a longitudinal retrospective comparison study to compare the chronic kidney disease (CKD) occurrences between PLWH and PLWH+DM from 2006 through 2015, and to compare the survival rates differences among PLWH, PLWH+DM, and PLWH+DM with CKD. In Aim 1, a total of 798 samples who had PLWH+DM in 2015 participated in this study. Most of the retention in care in PLWH+DM measurements were significantly correlated (p < 0.05). As to disease control, only CD4 cell count had relationships with retention in care measurements in all age groups, and hemoglobin A1c (HbA1c) level only occurred as a significant relationship with younger adults living with HIV with DM (YALWH+DM). Having the additional burden of some symptoms negatively affects retention in care in older adults living with HIV with DM (OALWH+DM). In Aim 2, a total of 10,063 samples had HIV infections in study. With having more comorbid conditions as well as increasing age at initial clinic visit, mortality rates increased. The mean survival time was 19.689 years (95% CI: 19.572-19.806). Having DM with PLWH, the mortality rates were three times higher than PLWH-only, and as for patients having DM with CKD in PLWH, the mortality rate was three times higher than PLWH+DM. According to the study, retention in care in PLWH+DM affects disease control and symptom burden (fatigue, sadness, memory loss) negatively in regard to the retention in care in OALWH+DM. Moreover, comorbid conditions have negative association with length of survival. Based on these findings, this study will contribute to the knowledge of comorbid conditions in PLWH as it applies to nursing practice, research, and policy.

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