Determinants of rapid progression to immunodeficiency syndrome among people infected with Human Immunodeficiency Virus, Kerala, India.

CONTEXT: Human Immunodeficiency Virus (HIV) infection progresses in almost all infected persons to Acquired Immunodeficiency Syndrome (AIDS). The aim of the study was to find out the determinants of rapid progression of immunodeficiency among people infected with HIV in Thiruvananthapuram district of Kerala, India. SETTINGS AND DESIGN: The study design used was case control. The setting of the study was antiretroviral treatment (ART) centre of Government Medical College and the self-help group of HIV patients located at Thiruvananthapuram, Kerala. MATERIALS AND METHODS: Cases were people having any one or more of the AIDS defining clinical conditions within 3 years from the diagnosis of HIV infection. Controls were people diagnosed as having HIV at least 3 years ago and with no AIDS-defining clinical conditions till the date of the study. Sample size was 149 with a control case ratio of 1.5:1. STATISTICAL ANALYSIS USED: Mean (standard deviation) and proportions were used to describe the data. Chi-square test and t test were done to test the hypotheses. Binary logistic technique was used to find out the predictors of the outcome. RESULTS: A regression (Binary Logistic) model was used to predict the progression. Fungal infection of nail [adjusted Odds Ratio (OR), 6.4 (1.4, 28.9)] and oral candidiasis [adjusted OR, 2.6 (1.1, 6.4)] were the clinical conditions significantly associated with rapid progression. The significant social factors included non-exposure to professional counseling [adjusted OR, 7.1 (2.0, 24.5)] and the feeling of being stigmatized - felt as preoccupation with thoughts that they are gossiped about and the increase in visitors to "check them out" [adjusted OR, 26.1 (4.9, 138.4)]. The protective nutritional factors in the model were frequent consumption of legumes [adjusted OR, 0.12 (0.04, 0.36)], eggs [adjusted OR, 0.29 (0.09, 0.93)], and plenty of oral fluids [adjusted OR, 0.18 (0.07, 0.47)]. CONCLUSIONS: An approach incorporating the clinical, social, and nutritional factors may retard the progression of HIV infection.