CLINICAL PREDICTORS OF DECLINES IN PHYSICAL FUNCTIONING IN PERSONS WITH AIDS - RESULTS OF A LONGITUDINAL-STUDY

Objective: This study was performed in an attempt to determine clinica l correlates of declines in physical functioning in people with AIDS. Design: An 8-month longitudinal cohort study was performed at three si tes in Boston, Massachusetts: a private academic group practice, an AI DS clinic at a public teaching hospital, and a staff-model health main tenance organization. Intermediate activities of daily living (IADLs), 10 symptoms and symptom complexes, mental health, and weight loss wer e assessed by interview in 201 persons with AIDS. Clinical diagnoses, comorbidities, laboratory results, and use of selected medications wer e assessed by chart review. Results: Participants were young (mean age , 36 years), 92% were male, 35% were nonwhite, and 27% had a history o f injection drug use. The mean 8-month decrement in physical functioni ng was 9.6 points on a 100-point scale, and mean weight loss was 2.3 k g. After adjusting for baseline functioning, age, sex, race, and educa tional level, independent predictors of the 8-month IADL score include d worsening fatigue (p = .0002), worsening neurologic symptoms (p =.00 1), weight loss (p =.0001), Candida esophagitis (p =.020), hypertensio n (p =.0005), depression (p =.004), and gastrointestinal (GI) disease (p =.018, model R-2 = 0.56). Conclusions: Two symptom complexes (fatig ue and neurologic symptoms), three comorbidities (hypertension, depres sion, and GI disease), and weight loss were significant independent pr edictors of 8-month IADL scores after statistically controlling for ba seline IADL score and sociodemogaphic variables. These clinical factor s are potential targets for interventions designed to improve physical functioning.