Physical disability in a cohort of persons with AIDS

Abstract

Physical disability is one of the more important determinants of health-related quality of life in person with AIDS, although little information is available on specific physical functional deficits. The purpose of this study was to document the types, frequency, severity, and correlates of physical disability in persons with AIDS. The design was cross-sectional with assessment of disability at the initial evaluation for the AIDS Time-Oriented Health Outcome Study, an observational community-based cohort of persons with AIDS. Disability was measured by the HIV Health Assessment Questionnaire, a self-administered assessment of perceived difficulty in eight functional categories. Additional medical and demographic information was obtained from chart review, in addition to other standardized quality of life measures. The sample consisted of 546 persons, primarily white homosexual men, evaluated a mean of 475 days (SD, 474) after an AIDS-defining diagnosis. Ten to 50% of men reported some degree of activity-specific disability, mostly mild or moderate. Disability scores varied widely and tended to be most severe among those items considered to be high level 'instrumental activities of daily living'. Univariate correlations were strong between disability and number of symptoms, global health status, and the Medical Outcomes Study HIV fatigue index (r = -0.4223 to 0.5115 for men). Correlations between disability and either time from AIDS diagnosis or CD4 T-lymphocyte count were not statistically significant. For men, stepwise multiple regression showed that 26.9% of disability variance was explained by symptoms, 3.7% by the Medical Outcomes Study HIV fatigue index, and 1.8% by total number of opportunistic infections. We conclude that physical function is variable among persons with AIDS living in the community, with a substantial number experiencing mild to moderate deficits tending to occur in instrumental activities of daily living. Further studies should address the need for and efficacy of appropriate rehabilitation interventions in persons with AIDS experiencing physical disability.