Special Coverage of 43rd IDSA Meeting
Self-rated health tool may have prognostic use in HIV treatment
A new study has found that HIV patients who self-rate their health as fair, poor, or bad predict increased mortality several years down the road.1
Self-rated health tools among geriatric populations have been studied extensively as a tool to assess prognosis, but they haven’t been used as often in younger patient populations, says Jonathan Shuter, MD, an associate professor of medicine in the division of infectious diseases at Montefiore Medical Center in Bronx, NY.
So in 2000 and 2001, investigators used the same self-rating concept to see if answers to health questions posed to HIV patients with a mean age of 42 were predictive of increased mortality.1
Their study found that a health self-assessment among HIV patients is a potentially valuable diagnostic tool, Shuter says.
When responses were clumped into good or excellent versus poor to bad, there was a significant difference between survival rates at a median follow-up of four years, Shuter says.
"In a multivariant analysis we found that this result fell out, and it was not an independent predictor of survival," Shuter says. "The only independent predictor was a history of AIDS, as defined by the Centers for Disease Control and Prevention (CDC), and also whether they received highly active antiretroviral therapy at the visit."
Interestingly, the patient’s CD4 cell count also was not predictive, Shuter notes.
"When something doesn’t work out to be an independent predictor, it could mean a few things," Shuter says. "We only had 175 patients in the study, and the follow-up was four years, which is not long enough, and we had 30 deaths."
With 83% of the cohort surviving at the end of the follow-up period, there might not have been enough power to demonstrate an independent predictive value for this variable, Shuter says.
The tool is very easy for a clinic to use, taking only about one minute, and it still could shed light on an HIV patient’s current and future health, Shuter says. (See chart of self-rated health tool.)
Also, one of the researchers on the study, Cedric Cheung, MD, has an interest in simplifying HIV disease prognosis in the underdeveloped world, and this tool potentially could be useful in resource-poor areas where it’s difficult to obtain CD4 cell counts and viral load data, Shuter says.
As the study notes, if the study is duplicated and validated in a resource-constrained country, it might prove to be a simple and inexpensive method to identify high risk patients requiring intensified monitoring.1
"It’s something to think about," Shuter says. "You would have to assess the tool in those cultures where the way people assess their own health is different."
Reference:
- Cheung C, Clark J, Shuter J. An evaluation of self-rated health as a prognostic tool in HIV infected patients. Presented at the 43rd Annual Meeting of the Infectious Diseases Society of America, Oct. 6-9, 2005, in San Francisco, CA. Abstract: 755.
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