- HIV-infected persons report more barriers to care and poor mental health compared to those without HIV infection.
- These factors increase 5-years mortality following HIV testing regardless of serostatus and should be used to identify high-risk individuals.
Contextual factors have an important effect on survival of people living with HIV, but little is known in resource-limited settings. In this study (conducted in Durban, South Africa) authors identified some contextual predictors of mortality which may be used to identify high-risk individuals requiring intensive follow-up, regardless of serostatus.
Over 4,816 adults (median age: 31 years) enrolled prior to HIV testing, 1,897 (39%) were HIV-infected. Survival data were available for 2,508 participants: 380 (15%) died during a median follow-up of 5.8 years.
Barriers to care were reported in greater number in HIV-infected patients, negatively affecting survival, regardless of HIV status. Each additional barrier domain increased the hazard ratio (HR) of dying by 11% in both participants.
Further, HIV-infected participants had worse mental health than those without HIV infection, but poor mental health increased mortality risk in both groups: for every 10-point decrease in mental health score, mortality increased by 7%.
Mortality risk was higher in HIV-infected individuals compared to HIV-uninfected participants, but varied by age: HR varied from 6.59 at 20 down to 1.13 at 60.
Limitations: the analysis was not adjusted for ART use; psychotic symptoms and comorbidities were not considered.