Functional status transitions and survival in HIV disease: evidence from the AIDS Costs and Service Utilization Survey.

Objective: The authors examined the prevalence of limitations in physical functioning in a large sample of people with human immunodeficiency virus (HIV) infection and the patterns of change in their functional status with time.

Methods: Patients receiving treatment for HIV infection were sampled from 26 providers in 10 cities across the United States; the analytic sample included 1,784 adults with HIV infection. Functional status was measured three times during a 12-month period. Respondents indicated whether they were limited in their ability to perform six activities, ranging from vigorous activities to bathing and dressing. Responses to the six items were combined to form an index of physical functioning. Medical records were used to determine stage of HIV infection, and death records were used to determine vital status. Changes in functional status during a 1-year period were assessed; correlates of change were examined using multinomial logistic regression, with "deceased" included as an outcome state.

Results: Limitation was most prevalent for vigorous activities (55%) and least prevalent for activities of daily living (12%). For each activity, the prevalence of limitations rose with increasing disease severity. During 1 year, 43% of respondents did not change in functional status, whereas 42% became worse and 15% reported improved functioning. Controlling for prior functional status, multivariate analyses showed that declines in functioning were related to developing acquired immunodeficiency syndrome (AIDS), to prior reports of fatigue, and to poor self-rated health. These same variables also predicted mortality.

Conclusions: Results suggest that the most prevalent types of home care assistance needed by those with HIV disease involve help with energy-demanding activities, such as shopping, and that nonuniform patterns of change in functioning necessitate flexible programs to meet frequently changing needs.