FUNCTIONAL STATUS OF PERSONS WITH HIV-INFECTION IN AN AMBULATORY SETTING

The objective of this project was to study the functional status of HI V-infected persons seen in an ambulatory care setting. We reviewed bas eline clinical and demographic data on patients with HIV infection pre senting for care between December 1988 and May 1991 at the HIV Clinic of the Johns Hopkins Hospital, an urban, primary care institution. Fun ctional status was assessed at baseline in a comprehensive psychosocia l assessment. Patients were asked to report on their ability to perfor m six activities of daily living (ADL) and nine instrumental activitie s of daily living (IADL). The main outcome measures were dependency in one or more ADL and death as ascertained by review of clinic death re cords and Maryland State Death Registries. All 728 patients had assess ments of functional status. Of these, 18% reported dependencies in one or more activity, with most of these (14%) reporting dependencies in IADLs only. Dependencies were more common in persons with an AIDS diag nosis (32% vs. 15%, p < 0.001). The majority of the dependencies repor ted by AIDS patients were also in IADLs. Mean CD4 counts were lower fo r persons reporting dependencies than for those who reported no depend encies (p = 0.02). No independent associations were found between func tional limitation and demographic variables. The risk of death was gre ater in patients with dependencies than in patients with no dependenci es, even when adjusting for CD4 count and AIDS diagnosis (O.R. = 2.32, p = 0.001). Proportional hazards modeling showed that mortality was i ndependently associated with an AIDS diagnosis (hazard ratio 1.82, p = 0.05), CD4 count <200/mm(3) (hazard ratio 2.37, p = 0.01), and CD4 <2 00/mm(3) and functional dependency (hazard ratio 3.45, p = 0.056). The majority of patients is this population had no functional dependencie s at their initial visit, including patients with AIDS. Those patients who did have dependencies were more likely to need assistance with ac tivities necessary for independent living, such as cooking or shopping , rather than for self care. For patients with advanced HIV disease, f unctional dependencies are associated with a greater risk of death.