Psychological distress and progression to AIDS in a cohort of injection drug users

Objective: We investigated whether distress was independently associated with more rapid progression to AIDS among HIV-infected injection drug users (IDUs). Design: A cohort study of IDUs in Baltimore followed from 1988 through 1999. A total of 451 IDUs met the eligibility criteria of being HIV-seropositive but AIDS-free at baseline. Methods: We used Cox proportional hazards models to investigate progression to AIDS within 2 years of baseline, controlling for CD4 lymphocyte count, HIV-1 viral load, and oral thrush. Results: Of the 451 participants, 76.3% were male and 95.8% were African-American; the median age at enrollment was 34 years. The cumulative incidence of AIDS within 2 years of baseline was 7.1%. In multiple regression analysis, distress was associated with more rapid time to AIDS (adjusted relative hazard [RH] = 2.39; 95% CI: 1.16-4.90). The strongest association was observed among IDUs with the lowest (<200 x 10⁶/L) CD4 counts (adjusted RH = 4.94; 95% CI: 1.30-18.77). Conclusions: Psychological distress was independently associated with shorter time to AIDS among HIV-infected IDUs, especially among those with the lowest CD4 cell counts, but was not predictive of mortality in this cohort. Further study of the effects of psychological distress on AIDS progression within this population is warranted.