Gender differences in health-related quality of life in patients with HIV/AIDS

The relationship between gender, psychosocial factors, pain, health literacy and health-related quality of life in parents of Norwegian adolescents one year into the COVID-19 pandemic

BACKGROUND

Stress impacts healthy behaviours and may influence life and health-related quality of life (HRQOL). A stressful event occurred when the COVID-19 pandemic hit in March 2020. The present study aims to explore possible gender differences in stress, psychosocial factors (self-efficacy, self-esteem, loneliness), pain, HL, and HRQOL in parents of adolescents one year into the COVID-19 pandemic, and to explore possible associations between gender, demographic and psychosocial factors, pain, HL, and HRQOL.

METHODS

Parents of adolescents aged 16-17 took part in the study from January to February 2021, when the COVID-19 pandemic was ongoing. Data on socio-demographics, stress, self-efficacy, self-esteem, pain, HL, loneliness, and HRQOL were collected. HRQOL was assessed using RAND-36.

RESULTS

Among the 320 parents from the general population, the mean age was 47.6 (standard deviation (SD) = 4.6) years, 81% were mothers, 79% were married or cohabiting, 81% had a university degree, and the majority worked full time (78%) or part time (13%). The average pain score was low, 0.48 (95% CI [0.43-0.54]). However, 50% of the parents reported persistent pain and more mothers reported persistent pain compared to fathers (53% vs. 37%). The parents' mean (SD) score for RAND-36 was 52.1 (95% CI [51.2-53.0]) for the physical component summary (PCS) score and 51.0 (95% CI [50.0-52.1]) for the mental component summary (MCS) score. Mothers reported significantly lower scores for all the eight RAND-36 domains and the PCS and MCS scores. Adjusting for gender, age, living condition, education, pain, HL, self-efficacy and loneliness, we revealed no associations between stress and RAND-36-PCS. University education of four years or more was positively associated (B = 3.29, 95% CI: [0.78-5.80]) with RAND-36-PCS, while persistent pain was negatively associated (B = -7.13, CI: [-9.20- -5.06]). We identified a strong negative association between RAND-36-MCS and stress (B = -43.11, CI: [-48.83- -37.38]) and a positive association with older age (B = 0.21, CI: [ 0.04, 0.39)].

CONCLUSION

One year into the COVID-19 pandemic, we identified a strong negative association between stress and mental HRQOL, while pain was strongly negatively associated with physical HRQOL.

Health-related quality of life in a european sample of adults with early-treated classical PKU

BACKGROUND

Phenylketonuria (PKU) is a rare inborn error of metabolism affecting the catabolism of phenylalanine (Phe). To date, findings regarding health-related quality of life (HRQoL) in adults with early-treated classical PKU are discrepant. Moreover, little is known about metabolic, demographic, and cognitive factors associated with HRQoL. Hence, we aimed to investigate HRQoL and its association with demographic, metabolic, and cognitive characteristics in a large European sample of adults with early-treated classical PKU.

RESULTS

This cross-sectional study included 124 adults with early-treated classical PKU from Hungary, Italy, Spain, Switzerland, and Turkey. All participants prospectively completed the PKU quality of life questionnaire (PKU-QoL), a questionnaire specifically designed to evaluate the impact of PKU and its treatment on HRQoL in individuals with PKU. In addition, information about Phe levels (concurrent and past year), demographic (age and sex), and cognitive variables (intelligence quotient, IQ) were collected. Most domains revealed little or no impact of PKU on HRQoL and more than three-quarters of the patients rated their health status as good, very good, or excellent. Nevertheless, some areas of concern for patients were identified. Patients were worried about the guilt that they experience if they do not adhere to the dietary protein restriction and they were most concerned about high Phe levels during pregnancy. Further, tiredness was the most affected symptom, and the supplements' taste was considered a main issue for individuals with PKU. The overall impact of PKU on HRQoL was higher in women (U = 1315.5, p = .012) and in adults with a lower IQ (rs = - 0.448, p = .005). The overall impact of dietary protein restriction was higher in adults with higher concurrent Phe levels (rs = 0.272, p = .007) and higher Phe levels during the past year (rs = 0.280, p = .009).

CONCLUSION

The impact of PKU on most domains assessed in the PKU-QoL was considered to be low. These results likely reflect the successful implementation of the newborn screening resulting in the prevention of severe adverse long-term outcomes. However, a particular clinical focus should be given to patients with lower IQ, higher Phe levels, and women, as these variables were associated with a lower HRQoL.

Preventing cardiovascular disease in midlife women with HIV: An examination of facilitators and barriers to heart health behaviors

Midlife women with HIV (WWH) are disproportionately impacted by cardiovascular disease (CVD), yet little is known about perceptions of CVD risk and the factors that influence engagement in heart health behaviors in this population. Few (if any) studies have used a qualitative approach to examine these perceptions, which has important implications for minimizing the negative impact of HIV-related noncommunicable diseases, the risk for which increases after midlife. Eighteen midlife WWH (aged 40-59) in Boston, MA, completed semistructured interviews to explore perceptions of CVD, HIV, and barriers and facilitators to healthy lifestyle behaviors. Interviews were analyzed via thematic analysis. Participants viewed heart health as important but were unaware of HIV-associated CVD risk. Facilitators included family and generational influences, social support, and access to resources. Physical symptoms, menopause, mental health challenges, and limited financial resources were barriers. Midlife WWH may benefit from tailored CVD prevention interventions that target their unique motivations and barriers to healthy behaviors.

Determinants of Depressive Symptoms in People Living with HIV: Findings from a Population-Based Study with a Gender Perspective

Depressive symptoms are common among people living with HIV (PLWH). The aim of this study was to identify the determinants of depressive symptoms in PLWH in Spain. A total of 1060 PLWH participated in this cross-sectional study and completed the Patient Health Questionnaire-9. The odds ratios for the presence of depressive symptoms were analyzed in a multivariable logistic regression model, including sociodemographic data, comorbidities, health-related behaviors, and social-environment-related variables. We found an overall prevalence of depressive symptoms of 21.42%; by subgroup, namely men, women, and transgender persons, prevalence was 18.13%, 32.81%, and 37.14%, respectively. Moreover, social isolation (OR = 1.05 [CI, 1.02-1.08]) and poor physical and mental quality of life (OR = 1.06 [CI, 1.02-1.09] and OR = 1.13 [CI, 1.09-1.17], respectively) were associated with depressive symptoms. As protective factors, we identified serodisclosure to more people (vs. none; OR = 0.39 [CI, 0.17-0.87]), satisfaction with social roles (OR = 0.86 [CI, 0.79-0.94]), better cognitive function (OR = 0.92 [CI, 0.89-0.95]), and sexualized drug use once in a lifetime (OR = 0.52 [CI, 0.29-0.93]). This study showed a high prevalence of depressive symptoms in PLWH, especially among women and transgender people. The association between psychosocial variables and depressive symptoms highlights the multidimensionality of the problem and identifies areas for intervention. This study found that the management of mental health issues is an area that needs to be improved and tailored to specific groups, with the aim of enhancing the well-being of PLWH.

Gendered differences in perceptions and reports of wellbeing: A cross-sectional survey of adults on ART in Malawi

Few studies have examined gender differences in reported quality of life among persons living with HIV (PLWH) in low-income countries. We conducted a cross-sectional survey of adults on antiretroviral therapy in Malawi, including questions focused on wellbeing, and collected clinical data on these respondents. We compared men's and women's self-reported health and wellbeing using Poisson models that included socio-demographic covariates. Approximately 20% of respondents reported at least one physical functioning problem. In multiple variable models, men were significantly more likely to have a high viral load (≥200 copies/mL; aIRR 2.57), consume alcohol (aIRR 12.58), receive no help from family or friends (aIRR 2.18), and to feel worthless due to their HIV status (aIRR 2.40). Men were significantly less likely to be overweight or obese (aIRR 0.31), or report poor health (health today is not "very good;" aIRR 0.41). Taken together, despite higher prevalence of poor self-rated health, women were healthier across a range of objective dimensions, with better viral suppression, less alcohol use, and less social isolation (although they were more likely to have an unhealthy BMI). Research that includes multi-dimensional and gender-specific measurement of physical, mental and social health is important for improving our understanding of well-being of PLWH.

Gender Differences in Visual Functioning Questionnaire Scores among Patients with Age-Related Macular Degeneration

PURPOSE

To examine gender differences in visual functioning using the National Eye Institute Visual Functioning Questionnaire-25 (VFQ-25) in a Colorado cohort of patients with age-related macular degeneration (AMD).

METHODS

A retrospective cohort study was conducted using a registry of AMD patients who attended the Sue Anschutz-Rodgers Eye Center (2014 to 2019). Demographic, clinical, and image data were collected, and AMD was categorized as Early/Intermediate AMD, or unilateral/bilateral neovascular (NV) AMD, geographic atrophy (GA), or Both Advanced using the Beckman Classification. Each patient completed the VFQ-25, which evaluates visual functioning, generating a composite score and subscale scores for vision-specific activities. Univariate and multivariable general linear models were used to estimate the associations between gender and VFQ-25 scores with parameter estimates (PE) and standard errors (SE).

RESULTS

Among 739 patients with AMD, 294 (39.8%), 115 (15.6%), 168 (22.7%), and 162 (21.9%) were diagnosed with Early/Intermediate AMD, GA, NV AMD, and Both Advanced, respectively. Adjusted for AMD classification, age and habitual visual acuity in the better-seeing and worse-seeing eyes, female gender was not significantly associated with lower composite VFQ-25 scores (PE (SE): -1.2 (0.9), p = .193), and was significantly associated with reportedly worse ocular pain and driving subscale scores (PE (SE): -4.6 (1.0), p < .0001 and -9.1 (2.1), p < .0001, respectively).

CONCLUSION

Gender plays a role in reported driving activities and ocular pain among patients with AMD. This may need to be accounted for in future research related to the use of VFQ-25 for AMD.

Transportation Barriers and Health-Related Quality of Life in a Sample of Middle-Aged and Older Adults Living with HIV in the Deep South

Access to reliable transportation is a social determinant of health imperative for disease management for those aging with HIV/AIDS. To what degree transportation barriers are associated with health-related quality of life (HRQOL) in middle-aged and older people living with HIV (PWH) in the Deep South region of the United States is presently unknown. PWH (n = 261, age range = 39 to 73 years old, 80.1% African American, 64.4% male) were recruited from an academic medical center in the Deep South. Variables included sociodemographics, HIV characteristics, depressive symptoms, HRQOL, and perceived transportation barriers. Spearman rho correlations and linear regressions accounting for covariates were conducted. After accounting for covariates, greater perceived transportation barriers were associated with worse health perceptions, pain, social functioning, health distress, and health transitions. Access to reliable transportation is a key factor in improving health for PWH. Considerations for healthcare and traffic safety are discussed.

A randomized comparison of health-related quality of life outcomes of dolutegravir versus efavirenz-based antiretroviral treatment initiated in the third trimester of pregnancy

Introduction

Evidence on health-related quality of life (HRQoL) outcomes is limited for new antiretroviral therapies (ART). Dolutegravir-based treatment is being rolled out as the preferred first-line treatment for HIV in many low- and middle-income countries. We compared HRQoL between treatment-naïve pregnant women randomized to dolutegravir- or efavirenz-based ART in a clinical trial in Uganda and South Africa.

Methods

We gathered HRQoL data from 203 pregnant women of mean age 28 years, randomized to either dolutegravir- or efavirenz-based ART. We used the medical outcomes study-HIV health survey at baseline, 24 and 48 weeks between years 2018 and 2019. Physical health summary (PHS) and mental health summary (MHS) scores were the primary study outcomes, while the 11 MOS-HIV subscales were secondary outcomes. We applied mixed model analysis to estimate differences within and between-treatment groups. Multivariate regression analysis was included to identify associations between primary outcomes and selected variables.

Results

At 24 weeks postpartum, HRQoL scores increased from baseline in both treatment arms: PHS (10.40, 95% CI 9.24, 11.55) and MHS (9.23, 95% CI 7.35, 11.10) for dolutegravir-based ART; PHS (10.24, 95% CI 9.10, 11.38) and MHS (7.54, 95% CI 5.66, 9.42) for efavirenz-based ART. Increased scores for all secondary outcomes were significant at p < 0.0001. At 48 weeks, improvements remained significant for primary outcomes within group comparison. Estimated difference in PHS were higher in the dolutegravir-based arm, while increases in MHS were more for women in the efavirenz-based armat 24 and 48 weeks. No significant differences were noted for corresponding PHS scores at these time points compared between groups. Differences between arms were observed in two secondary outcomes: role function (1.11, 95% CI 0.08, 2.13), p = 0.034 and physical function outcomes (2.97, 95% CI 1.20, 4.73), p = 0.001. In the multivariate analysis, internet access was associated with higher PHS scores while owning a bank account, using the internet and longer treatment duration were associated with an increase in MHS scores.

Conclusion

We found no important differences in HRQoL outcomes among HIV-positive women started on dolutegravir relative to efavirenz in late pregnancy. Increases in HRQoL in the first year after delivery provide additional support for the initiation of ART in HIV-positive women presenting late in pregnancy.

Trial Registration Clinical Trial Number: NCT03249181

Patterns of mental health symptoms among women living with HIV ages 45-60 in England: associations with demographic and clinical factors

OBJECTIVE

We aimed to describe the prevalence of various mental health symptoms according to menopausal status (pre, peri, post) among women living with HIV ages 45-60 in England, and to identify groups of women with similar general and menopause-related mental health symptoms. We then investigated demographic predictors of group-membership and group differences in HIV-related care outcomes (antiretroviral therapy adherence, HIV clinic attendance, CD4-count, and last HIV viral load).

METHODS

An analysis of cross-sectional data from the Positive Transitions through Menopause study, an observational study of the health and well-being impacts of menopause on 869 women with HIV aged 45-60 years. Self-reported data on eight mental health indicators were collected from women in pre-, peri- and post-menopausal state using validated measures. Groups (termed "classes") of women with similar mental health symptoms were derived via latent class analysis. Class membership was linked to demographic factors using nominal logistic regression, and to clinical outcomes using Wald tests.

RESULTS

We identified five classes: 1) few mental health symptoms (n = 501, 57.8%); 2) high current anxiety/depression (n = 120, 13.8%); 3) history of depression, with elevated current substance use (n = 40, 4.6%); 4) history of depression with current psychological menopause symptoms (n = 81, 9.3%); and 5) high previous and concurrent mental health problems (n = 125, 14.4%). University attendance, ethnicity, and longer time since HIV diagnosis predicted class membership. Antiretroviral therapy adherence was lower in classes 3 (11%), 4 (19%) and 5 (24%) compared to class 1 (4%; all P<0.001). Members of class 5 were more likely to have missed ≥1 HIV clinic appointment in the past year than those in class 1 (34% vs 17%, P = 0.005).

CONCLUSIONS

Women with a history of depression, current anxiety/depression, and current menopause-related mental health symptoms were more likely to have poorer clinical outcomes. Although we cannot comment on causality, our findings highlight the importance of assessing and managing menopausal symptoms and mental health to improve well-being and engagement in HIV care.

Cross-sectional investigation of gender differences in health-related quality of life among HIV patients: implications for gender mainstreaming in HIV management

Introduction

health-related quality of life (HRQoL) can be affected by the existence of long-term medical conditions. This study compared the HRQoL of male and female patients living with the human immunodeficiency virus (HIV) who sought care at the antiretroviral clinic in a tertiary hospital.

Methods

a comparative cross-sectional study with 512 female and 512 male HIV outpatients receiving care at the antiretroviral clinic in the University of Port Harcourt Teaching Hospital. The WHOQoL-HIV-BREF which conceptualized HRQoL as a function of six factors - physical, psychological, social, environment, independence and spiritual health was administered. The gender difference in HRQOL was determined by the independent sample t-test, mean difference and standardized mean difference in items and domain scores. Meta-analytic approach was used to deduce the overall potential effect of gender on HIV infection. Multivariate linear regression analyses were used to control for potential confounders of HRQoL among the study participants.

Results

the mean age of the sampled population was 35.9 ± 11.8 years for the male and 35.3 ± 9.8 years for the female category. Male HIV patients reported significantly higher mean HRQoL scores across all domains of the scale except the spiritual domain. The 4.51% (95% CI of 3.63 to 5.39%) overall difference was statistically significant (p<0.001). Other factors associated with good HRQoL were marriage status, monogamous family type and a higher level of education.

Conclusion

the significantly lower HRQoL among female HIV patients calls for a multiprong approach towards strengthening gender mainstreaming in the management and control of HIV patients in Nigeria.

Perinatal Depressive Symptoms, HIV Suppression, and the Underlying Role of ART Adherence: A Longitudinal Mediation Analysis in the IMPAACT P1025 Cohort

Background

Women with HIV have higher risk of depressive symptoms in the perinatal period. Evidence on how perinatal depressive symptoms affect viral suppression (VS) and adherence to antiretroviral therapy (ART) remains limited.

Methods

Perinatal depressive symptoms were assessed using 6 items from the AIDS Clinical Trials Group (ACTG) Quality of Life questionnaire. VS (viral load <400 copies/mL) was the outcome. Adherence was defined as no missed dose in the past 1–4 weeks using the ACTG Adherence Questionnaire. Generalized mixed-effects structural equation models estimated the association of depressive symptoms on VS and the mediating role of ART adherence among women enrolled in the IMPAACT P1025 Perinatal Core Protocol (2002–2013).

Results

Among 1869 participants, 47.6% were 21–29 years, 57.6% non-Hispanic Black. In the third trimester, the mean depressive symptoms score was 14.0 (±5.2), 68.0% had consistent adherence, and 77.3% achieved VS. At 6 months postpartum, depressive symptoms declined while adherence and VS fell to 59.8% and 53.0%, respectively. In the fully adjusted model, a 1-SD increase in depressive symptoms was associated with a 3.8-percentage-point (95% CI: −5.7, −1.9) decline in VS. This effect is the sum of the indirect effect of depressive symptoms on VS via ART adherence (−0.4; 95% CI: −.7, −.2) and the direct effect through other pathways (−3.4; −5.2, −1.5). The decline in adherence driven by depressive symptoms accounted for ≥11% of the total negative effect of depressive symptoms on VS.

Conclusions

Perinatal depressive symptoms were associated with decreased adherence and VS, highlighting the need to screen for, diagnose, and treat perinatal depression to optimize maternal outcomes.

Clinical Trials Registration

NCT00028145.

Impact of diabetes and periodontal status on life quality

Objectives

To investigate impact of periodontal status on quality of life (QoL) in type-1 (T1D) and type-2 (T2D) diabetes patients pre- and post-periodontal treatment using the Well-being Questionnaire 12 (W-BQ12) and Audit of Diabetes-Dependent Quality of Life-19 (ADDQoL-19).

Methods

W-BQ12 and ADDQoL-19 were self-completed by 56 T1D and 77 T2D patients at baseline and by those with periodontitis 3 and 6-months after therapy.

Results

At baseline, T1D patients had significantly higher general W-BQ12 [Median (IQR); 24.00 (20.25–27.75)] and positive well-being scores [8.00 (6.00–9.00)] (indicating better QoL) compared to T2D patients [22.00 (15.50–26.00) and 6.00 (3.50–9.00)], respectively (p < 0.05). Within both groups, general W-BQ12 scores did not differ significantly between patients with periodontal health, gingivitis, or periodontitis (p > 0.05). Significantly higher general W-BQ12 scores were observed in T1D patients at month 3 [28.00 (22.00–29.50)] compared to baseline [22.00 (17.00–24.50)] (p < 0.01), suggesting an initial improvement in QoL post-treatment. ADDQoL-19 identified that diabetes had greatest impact on the domain ‘freedom to eat’, with participants placing most importance on ‘family life’. No significant changes in ADDQoL-19 scores were seen post-treatment (p > 0.05).

Conclusions

Diabetes had impacts upon aspects of life quality in both T1D and T2D patients, though any additional impact based on periodontal status was not observed when using W-BQ12 and ADDQoL-19.

A Multi-Dimensional Characterization of Aging and Wellbeing Among HIV-Positive Adults in Malawi

There is relatively little research on aging with HIV and wellbeing in sub-Saharan Africa. A cross-sectional survey was implemented in Malawi; eligible respondents were ≥ 30 years old and on ART for ≥ 2 years. Univariate and multiple regression analyses were stratified by age (younger adults: aged 30-49; older adults: aged ≥ 50) and gender. The median age was 51 years (total sample n = 134). Viral suppression was less common among older respondents (83.7% versus 93.0% among younger respondents) although not significant in adjusted models. Despite exhibiting worse physical and cognitive functioning (any physical functioning challenge: aOR 5.35, p = 0.02; cognitive functioning score difference: - 0.89 points, p = 0.04), older adults reported less interpersonal violence and fewer depressive symptoms (mild depression: aOR 0.23 p = 0.002; major depression: aOR 0.16, p = 0.004); in gender-stratified models, these relationships were significant only for females. More research is needed to disentangle the interplay between aging, gender and HIV in high-burden contexts and develop interventions to support comprehensive wellbeing in this population.

Sex Differences in People Aging With HIV

BACKGROUND

To evaluate differences between older women and men with HIV regarding HIV variables, comorbidity, physical function, and quality of life (QOL).

SETTING

The Modena HIV clinic.

METHODS

Prospective cohort study. Cross-sectional analysis. Patients >50 years were included, stratified by sex. We recorded sociodemographic data, comorbidities, variables related to HIV infection, frailty, data on body composition, physical function, physical activity, and QOL.

RESULTS

We evaluated 1126 older adults with HIV, of which 284 (25.2%) were women. Median age was 55 (IQR 6) years. There were significant differences between women and men in the median current CD4 T-cell and the mean CD4/CD8 ratio. There were differences regarding alcohol consumption, cardiovascular (CV) disease, hypertension, diabetes mellitus, and renal failure. Sarcopenia and slower gait speed were found more prevalent among men, but without significant differences. Significant differences were found regarding lower extremity strength measured by the chair stand test and in the short physical performance battery score. Short physical performance battery <9 was detected for 11.1% women vs. 5.6% men (P = 0.002). EQ5D5L score was 0.87 in women vs. 0.89 in men (P = 0.002).

CONCLUSIONS

In our cohort, older women represented one in 4 of the total patients. Despite the fact that women have better immunological recovery measured by CD4 T-cell count and CD4/CD8 ratio, and fewer CV disease and CV risk factors than men, their physical function and their QOL are worse. Therefore, older HIV-infected women have special characteristics, and the assessment of physical function in this group seems to be crucial.

Health-Related Quality of Life Among People Living with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy in Ethiopia: PROQOL-HIV Based Survey

Background

As infection with the Human Immunodeficiency Virus (HIV) has evolved into a chronic disease, perceived health-related quality of life (HRQoL) is becoming a prominent and important patient-reported outcome measure in HIV care. This study aimed to assess HRQoL among people living with HIV on highly active antiretroviral therapy and factors associated with HRQoL in Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 160 HIV–infected patients who were initiated highly active antiretroviral therapy at Jimma University Medical Center in 2016. HRQoL was assessed using the patient-reported outcome quality of life-HIV (PROQOL-HIV) measuring scale. Linear regressions were used to identify factors associated with outcome. Statistical significance was considered at p-value <0.05.

Results

Out of a total of 160 participants, 63.13% were females. The mean (±SD) age of study participants was 41.47±9.45 years. The median baseline CD₄+ cell count was 182.00 cells/µL (IQR: 104.53–262.40 cells/µL). The mean (±SD) score of PROQOL-HIV scale domains was 77.58 ±15.11, 58.32 ±7.79, 61.75± 17.95, 85.07 ±15.67, 76.92 ± 20.52, 80.00 ±16.83, 74.37 ± 1.47, 81.45 ± 8.17 for physical health and symptoms, emotional distress, health concerns, body change, intimate relationships, social relationships, stigma, and treatment impact domains, respectively. Second line antiretroviral therapy showed a negative effect on the quality of life, especially on the treatment impact domain (β=−6.301). Cotrimoxazole preventive therapy had a significant positive effect on the physical health and symptoms of HIV patients (β= +8.381, p<0.05). Advanced disease (β=−2.709, p<0.05), and non-communicable disease comorbidity (β=−14.340, p<0.001) showed a significant negative effect on physical health and symptoms.

Conclusion

Several behavioral, clinical & immunological factors were negatively associated with health-related quality of life. The double burden of chronic non-communicable disease(s) and the impact of treatment were highly significant in all dimensions of HRQoL measures. Therefore, with HRQoL emerging as a key issue for HIV–infected patients, its routine assessment and appropriate interventions at each clinic visit would be very crucial.

Health-Related Quality of Life and Associated Factors Among Adult HIV Mono-Infected and TB/HIV Co-Infected Patients in Public Health Facilities in Northeast Ethiopia: A Comparative Cross-Sectional Study

PURPOSE

This study was conducted to assess the health-related quality of life and associated factors among adult human immunodeficiency virus (HIV) mono-infected and tuberculosis (TB) and HIV co-infected patients in the public health facilities of northeast Ethiopia.

METHODS

A comparative facility-based cross-sectional study was conducted from February 01 to May 30, 2019. A total of 434 HIV mono-infected and 143 TB/ HIV co-infected patients were randomly selected for the study. The data were collected using an interviewer-administered structured questionnaire. The health-related quality of life of patients was measured using the World Health Organization quality of life HIV instrument which contains physical, psychological, social relationships, environmental, level of independence, and spiritual domains. The validated version of the Kessler scale was used to assess depressive symptoms. Linear regression analysis was performed to identify factors associated with the outcome variables, and a p-value < 0.05 with 95% CI was used to measure the degree of association between health-related quality of life and independent variables.

RESULTS

The mean scores of health-related quality of life among HIV mono-infected patients in terms of thephysical, psychological, level of independence, social relationships, environmental, and spiritual health domains were 63.9, 65.0, 60.5, 59.0, 56.4, and 63.9, respectively; whereas the mean scores among TB/HIV co-infected patients were 46.6, 48.5, 42.7, 43.5, 39.3, and 51.3, respectively. Among HIV mono-infected patients, being married improved the quality of social relationships by 6.7 compared with unmarried patients (β = 6.7, 95% CI = 3.24, 10.11); whereas among the TB/HIV co-infected patients, being educated increased the quality of social relationships by 10.6 compared with being uneducated (β=10.6, 95% CI=3.70, 17.51).

CONCLUSION

The study revealed that the TB/HIV co-infected patients had poor health-related quality of life in all domains compared with HIV mono-infected patients. Besides, depression and stigma were more prevalent among co-infected patients. Therefore, designing and implementing specific management that focuses on psychiatric centers for TB/HIV co-infected patients will be necessary as their quality of life is lowered.

Special Topics in the Care of Older People with HIV

PURPOSE OF REVIEW

Antiretroviral therapy has enabled many people with HIV to live long lives with their infection, but the literature suggests that long term survivors are developing comorbidities and aging-related syndromes at earlier ages than their non-infected counterparts. In addition, there is evidence or sex-based differences in comorbidity risk.

RECENT FINDINGS

How to best care for people aging with HIV is not known, but the tools of comprehensive geriatric assessment can identify people at risk for decline. Newer antiretroviral therapies offer promise of fewer side effects and drug interactions. We will also discuss special needs of women aging with HIV.

SUMMARY

People with HIV and their providers are often unprepared to confront issues of aging, and each clinical program must develop methods to assess older patient and manage age-related complications and syndromes.

Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study

Background

This study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18-60 years in the Philippines.

Methods

Prevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups.

Results

Overall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58-4.98%) for men and women aged 18-60 years. Genital warts prevalence was 3.39% (95% CI: 3.13-3.65%) and 8.0% (95% CI: 7.69-8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66-18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively).

Conclusions

Genital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.

Trajectories of Health-Related Quality of Life and Perceived Social Support Among People Living With HIV Undergoing Antiretroviral Treatment: Does Gender Matter?

The study examined the trajectories of health-related quality of life (HRQoL) and perceived social support (PSS) among people living with HIV (PLWH), with a special focus on gender differences. The participants included 252 PLWH (18% female) undergoing antiretroviral therapy. HRQoL (WHO Quality of Life-BREF; WHOQOL Group, 1998) and PSS (Berlin Social Support Scales; Schulz and Schwarzer, 2003) were measured three times at six-month intervals. Using a univariate approach, three trajectories of HRQoL and four trajectories of PSS were identified. Gender and relationship status were significant covariates for PSS only, with overrepresentation of single women in the increasing trajectory. The dual trajectory approach revealed a match in the decrease of HRQoL and PSS, but only for 31% of the sample. In fact, decreasing PSS co-occurred with increasing as well as stable HRQoL. There was no significant gender effect in this regard. Although a clear correspondence for decreasing trajectories exists, the findings also highlight a discrepancy between HRQoL and PSS changes that are unrelated to gender.

Changes health-related quality of life in HIV-infected patients following initiation of antiretroviral therapy: a longitudinal study

BACKGROUND

Several tools have been developed to evaluate HIV health-related quality of life (HRQoL) during and after antiretroviral therapy (ART). Few longitudinal studies evaluated the effect of ART on the quality of life of HIV patients.

OBJECTIVE

To evaluate changes in HRQoL in HIV-infected individuals one year after initiating ART.

METHODS

A prospective study was conducted from May 2016 to July 2018. Data on clinical and sociodemographic characteristics of 91 HIV-infected patients were collected prior to initiation of ART and one year thereafter. Demographic and clinical data were collected and the questionnaires 36-item Short Form Health Survey (SF-36) and HIV/AIDS-targeted quality of life (HAT-QoL) were administered in both periods. Asymptomatic individuals, aged ≥18 years, were included in the study. Patients who discontinued treatment were excluded. The association between predictors of physical and mental HRQoL was analyzed by multiple linear regression analysis.

RESULTS

Patients were predominantly male (78.0%), mean age 35.3 ± 10.7 years, with no stable relationship (80.2%), and no comorbidities (73.6%). Most of the SF-36 domains improved after one year, particularly Physical Function (p = 0.0001), General Health (p = 0.0001), Social Functioning (p = 0.0001), Mental Health (p = 0.001), and Mental Component Summary (p = 0.004). HAT-QoL domains improved in the Overall Function (p = 0.0001), Life Satisfaction (p = 0.0001), Provider Trust (p = 0.001), and Sexual Function (p = 0.0001) domains. Sex (p = 0.032), age (p = 0.001), income (p = 0.007), and stable relationship (p = 0.004) were good predictors of the Physical Component Summary. Sex (p = 0.002) and stable relationship (p = 0.038) were good predictors of the Mental Component Summary. SF-36 and HAT-QoL scales presented strong correlations, except for Medication Concerns (0.15-0.37), HIV Mastery (0.18-0.38), Disclosure Worries (-0.15 to 0.07), and Provider Trust (-0.07 to 0.15).

CONCLUSIONS

ART improved HRQoL after one year of use. The HAT-QoL and SF-36 correlated well and are good tools to evaluate HRQoL in HIV-infected patients on ART.

Health-related quality of life of people living with HIV infection in Spain: a gender perspective

Studies exploring gender differences in health-related quality of life (HRQOL) of people living with HIV/AIDS (PLWHA) are scarce and contradictory. This study evaluated gender differences in HRQOL of 744 PLWHA with median (IQR) age 44 (37-48) years and HIV infection diagnosed 12 (5-20) years earlier. Results showed important differences between genders (p < .05). Better male physical health was related to being employed, not having economic worries, not receiving psychological support, not having injected drugs in past, low negative mood HIV-related, low HIV illness representation and internalized stigma, and high body image satisfaction and health behavior. For women, variables were fewer years since HIV diagnosis and low enacted stigma-personal experience of rejection. Mentally, variables in men were being employed, not having injected drugs, having a stable partner, high health behavior, use of problem-solving coping, personal autonomy and personal meaning. In women, better mental health was related to high CD4 cells, self-esteem and body image satisfaction, and negative mood HIV-related. Men and women coincided in absence of past opportunistic infections being related to better physical and mental health, and absence of side effects for physical health and low HIV-related stress and HIV illness representation for mental health. Our results highlight the need for detailed study of gender differences that identify the bio-psycho-socio inequalities that affect HRQOL.

The impacts of depression and anxiety on quality of life among patients with HIV/AIDS and their spouses: testing dyadic dynamics using the actor-partner interdependence model

HIV/AIDS not only affects the patients, but also their entire family. This study aimed to assess the impacts of the patients' and their spouses' anxiety and depression on their quality of life (QoL) at the dyadic level. A total of 120 serodiscordant husband-wife dyads from the voluntary counselling and testing center in Shiraz, Iran, were involved in this study from February to June 2015. The WHOQOL-BREEF, CESD-10, and Beck Anxiety Inventory instruments were used, respectively, to assess the QoL, depression, and anxiety scores of the participants. The actor-partner interdependence model (APIM) was used to estimate the effects of depression and anxiety of both the people living with HIV/AIDS (PLWHA) and their spouses on their own QoL (actor effect) as well as their partners' (partner effect). The APIM analysis revealed that both PLWHAs' and their spouses' depression and anxiety showed actor effects on their own QoL. Furthermore, spouses' depression showed a significant partner effect on PLWHAs' QoL and PLWHAs' anxiety had significant partner effects on spouses' QoL. Accordingly, this data can be used to develop targeted interventions aimed at guidance and assistance of PLWHAs and their spouses to find coping strategies that improve their own QoL as well as their partners'.

Mediator and moderator effects on the relationship between HIV-positive status disclosure concerns and health-related quality of life

HIV-related stigma and the effect on quality of life is an on-going public health concern despite decades of education, prevention, and intervention efforts. The main purposes of this study were to examine the mediating role of four coping styles and the moderating role of gender on the relationship between HIV-positive status disclosure concerns and eight health-related quality of life outcomes. Data were collected from 346 women and men living with HIV. Results indicated that two coping styles - acquiring social support and positive reframing - mediated the negative relationship between disclosure concerns and health-related quality of life outcomes. There was no support for a moderated mediation. Interventions aimed at helping people living with HIV should focus on identifying and acquiring coping styles that transform perceptions of HIV-related stigma to support disclosure and improve health-related quality of life.

Positive and Negative Affect Change among People Living with HIV: a One-Year Prospective Study

PURPOSE

The aim of this study was to investigate the heterogeneity of changes in affective states, i.e., positive (PA) and negative (NA) affect, as well as the sociodemographic and clinical covariates of these changes among people living with HIV (PLWH) in a 1-year prospective study.

METHOD

Participants were 141 ambulatory patients (15% female) with a confirmed diagnosis of HIV infection who were undergoing antiretroviral treatment. Their affective states were assessed three times, with 6-month intervals, using the positive and negative general affect scale (PANAS-X). Sociodemographic (gender, age, relationship status, education, employment) and clinical variables (CD4 count assessed via self-report, HIV/AIDS status, time since HIV diagnosis and antiretroviral treatment duration) were also obtained.

RESULTS

Heterogeneity of changes was present only for NA, whereas PA decreased gradually in the whole sample. Time since diagnosis was unrelated to baseline affect levels as well as affect level changes. Additionally, the trajectories of NA and PA were independent of each other. The significant correlates of trajectories were gender and CD4 counts, both baseline CD4 levels and CD4 changes.

CONCLUSION

This study adds to the literature by describing affect changes among PLWH and identifying potential correlates of these changes, particularly CD4 count and gender. As such, these findings point to the potential clinical significance of further research on the roles of these variables.

Health-Related Quality of Life Among Homeless Smokers: Risk and Protective Factors of Latent Class Membership

Health-related quality of life (HRQoL) is a multidimensional assessment of well-being and health status. Most work in this area assumes that HRQoL is a homogenous construct; however, it is possible HRQoL subgroups may exist. The purpose of the study was to characterize common classes of HRQoL among adult, homeless smokers, a particularly vulnerable group of the larger population, and to evaluate risk and protective factors of HRQoL class membership. Homeless smokers (N = 456; 65.1% male; M_age = 43.19 years [SD = 11.77]) completed self-report measures of sociodemographics, smoking characteristics, anxiety sensitivity, stress, social support, and the Center for Disease Control (CDC) four-item HRQoL measure. A latent class analysis was conducted for HRQoL. Multinomial regression models were used to simultaneously test correlates of class membership. A three-class solution, consisting of poor HRQoL, moderate HRQoL, and excellent HRQoL, demonstrated superior fit. Correlates of class membership included sex, age, lifetime months of being homeless, smoking characteristics, anxiety sensitivity, stress, and social support. The current findings provide novel evidence for three distinct classes of HRQoL among homeless smokers. Results suggest that older smokers with greater emotional distress, as evidenced by greater anxiety sensitivity, greater stress, and less social support, may be particularly vulnerable to poorer HRQoL.

Association Between Health-Related Quality of Life and Physical Functioning in Antiretroviral-Naive HIV-Infected Patients

Background:

Poor functional status can significantly affect Health-Related Quality of Life (HRQoL) of HIV patients. However, there is scarce information on the functional profile of such patients before starting antiretroviral therapy (ART).

Objective:

To estimate the association between health-related quality of life and physical functioning in Antiretroviral-Naive HIV-infected patients.

Methods:

We conducted a cross-sectional study with HIV-infected patients older than 18 years, and naïve to antiretroviral therapy. The patients were evaluated for functional profile by pulmonary function (forced vital capacity, forced expiratory volume at one second, and Tiffeneau index), handgrip strength, and six-minute walk test in a cross-sectional study. HRQoL was evaluated by the 36-Item Short-Form Health Survey and its Physical (PCS) and Mental (MCS) Component Summaries. Multiple linear regression analyses were used to evaluate the association of predictor variables with PCS and MCS scores.

Results:

We found lower HRQoL among females patients, with far below average impairment of mental health component. Both male and female patients presented lower 6MWD function test values. Patients with dynapenia were older than patients without it, presented lower PCS mean score, lower family income, poor 6 MWD function test, lower FVC, and lower FEV1 t. Multivariable logistic regression analyses showed that Grip Strength, age and family income were predictor variables for Physical component of HRQoL. Female gender and smoking habit were predictive for the mental component of HRQoL.

Conclusion:

HRQoL in HIV, drug-naïve patients is predicted by level of dynapenia, smoking, income and gender. Therefore, lifestyle changes and active exercising can help to improve HRQoL in such patients.

Health-related quality of life and coping strategies among people living with HIV: the moderating role of gender

The aim of the study was to explore gender differences in the level of health-related quality of life (HRQoL) and coping strategies among people living with the human immunodeficiency virus (HIV) (PLWH). In particular, the moderating role of participants' gender on the relationship between coping strategies and HRQoL was explored, while controlling for socio-medical data. A total of 444 HIV-infected men and 86 HIV-infected women were recruited to participate in the study. This was a cross-sectional study with the HRQoL assessed by the World Health Organization (WHO) Quality of Life-BREF (WHOQOL-BREF) and the coping strategies measured by the Brief COPE inventory. Although the HIV-infected men and HIV-infected women differed in terms of some HRQoL domains, these differences disappeared in the regression analysis after controlling for socio-demographic data (employment and higher education). In addition, several statistically significant interactions between participants' gender and coping strategies in relation to HRQoL domains were observed. Future research on gender differences in HRQoL among PLWH should take into account unique differences between HIV-infected men and HIV-infected women across, not only in respect to socio-medical factors but also regarding psychosocial variables.

Gender difference in health related quality of life and associated factors among people living with HIV/AIDS attending anti-retroviral therapy at public health facilities, western Ethiopia: comparative cross sectional study

Background

Though HIV/AIDS has multidimensional consequences on quality of life, there is a gap in measuring and monitoring health related quality of life of HIV/AIDS patients. Hence, this study intended to measure health related quality of life domains and associated determinants among people living with HIV/AIDS in western Ethiopia.

Methods

A comparative cross-sectional study was conducted among 520 HIV/AIDS patients on anti-retroviral therapy in public health facilities in West Shoa Zone, Western Ethiopia from April to May, 2016. Participants were selected using simple random sampling method. Quality of life was measured using WHOQOL-HIV BREF and depression was assessed using Beck Depression Inventory, Second Edition (BDI-II). Data were analyzed using SPSS version 22. An independent sample t-test was used to compare quality of life domains between men and women and logistic regression analysis was used to determine independent predictors.

Results

Females had significantly lower quality of life in physical, psychological, independence and environmental domains as compared with males except social relationship and spiritual domains. Depressed HIV patients had significantly lower quality of life in all domains as compared with HIV infected patients without depression in both genders. Malnutrition and anemia were significantly associated with poor physical, psychological, independence and environmental domains. Anemic women had 1.9 times lower independence quality of life compared with women who had no anemia (AOR = 1.9, 95%CI: 1.4, 3.5). Tuberculosis was also predictor of physical, psychological, independence and social domains in both genders. TB/HIV co-infected females had 2.0 times poorer environmental health compared to only HIV infected females (AOR = 2.0, 95%CI: 1.2, 3.5). Family support, education and occupation were also independent significant predictors of QOL domains in both genders. In females, residence was significantly associated with independence (AOR = 1.8, 95%CI: 1.2–3.8) and environmental (AOR = 1.5, 95%CI: 1.1–3.2) domains.

Conclusions

Females had significantly lower quality of life compared with males. The findings indicted poor socio-economic status and co-infections significantly associated with poor quality of life among HIV/AIDS patients. So, due emphasis should be given to improve socio-economic status and enhance integrated early detection and management of malnutrition, depression, tuberculosis and anemia among HIV/AIDS patients in Ethiopia.

The role of personal and household members' substance use in health-related quality of life in women living with HIV/AIDS

Advances in HIV treatments have led to a greater focus on health-related quality of life (HRQOL) among people living with HIV/AIDS. The current study examined factors associated with HRQOL among 378 women in HIV care. HRQOL was measured using a modified version of the 12-Item Short Form Health Survey; scores were derived for the mental and physical composite summaries (MCS and PCS). We measured personal alcohol use and drug use. Household members' substance use were assessed by asking participants about the alcohol/drug status of persons with whom they live. Multivariate generalized linear models were used to estimate the linear association between MCS and PCS scores and personal and household members' alcohol and drug use. We found lower MCS scores were significantly associated with personal alcohol use and living with someone with alcohol or/and drug problems. Lower PCS scores were not significantly associated with personal alcohol use or living with someone with alcohol or/and drug problems. Findings suggest that universal screening and targeted interventions for alcohol use by the patient or household members may offer potential strategies for improving mental health quality of life among women living with HIV/AIDS.

Effect of Health Care on Quality of Life among Human Immunodeficiency Virus Infected Adults With and Without Visceral Leishmaniasis in northwest Ethiopia: A Longitudinal Follow-Up Study

There has been a scarcity of data on the effect of health care on the quality of life (QoL) of human immunodeficiency virus (HIV)- and visceral leishmaniasis (VL)- coinfected patients over time. We sought to assess the change that health care brings about in the QoL of HIV patients with and without VL and its predictors in 6 months. A total of 465 HIV patients without VL and 125 HIV-VL-coinfected patients were enrolled in the longitudinal follow-up study from October 2015 to September 2016. Data on QoL at baseline and in 6 months were collected by trained nurses through face-to-face interviews using a short Amharic version of World Health Organization QoL instrument for HIV clients. Multiple linear regressions were used to assess the predictors of health-related QoL. There was an improvement in all of the domains of QoL at the sixth month follow-up compared with the baseline for both groups of patients (P < 0.001). Lack of social support and income were associated with the low improvement in QoL in most of the domains in both groups. Compared with patients having severe acute malnutrition, patients having moderate acute malnutrition and normal nutritional status were better in most of the QoL domains in both groups of patients. Both antiretroviral and anti-VL treatments showed improvement in all dimensions of QoL. Income, social support, and nutritional status were the predictors for most of the QoL domains.

Cohort profile: The Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS)

Globally, women are at increased vulnerability to HIV due to biological, social, structural, and political reasons. Women living with HIV also experience unique issues related to their medical and social healthcare, which makes a clinical care model specific to their needs worthy of exploration. Furthermore, there is a dearth of research specific to women living with HIV. Research for this population has often been narrowly focused on pregnancy-related issues without considering their complex structural inequalities, social roles, and healthcare and biological needs. For these reasons, we have come together, as researchers, clinicians and community members in Canada, to develop the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) to investigate the concept of women-centred HIV care (WCHC) and its impact on the overall, HIV, women's, mental, sexual, and reproductive health outcomes of women living with HIV. Here, we present the CHIWOS cohort profile, which describes the cohort and presents preliminary findings related to perceived WCHC. CHIWOS is a prospective, observational cohort study of women living with HIV in British Columbia (BC), Ontario, and Quebec. Two additional Canadian provinces, Saskatchewan and Manitoba, will join the cohort in 2018. Using community-based research principles, CHIWOS engages women living with HIV throughout the entire research process meeting the requirements of the 'Greater Involvement of People living with HIV/AIDS'. Study data are collected through an interviewer-administered questionnaire that uses a web-based platform. From August 2013 to May 2015, a total of 1422 women living with HIV in BC, Ontario, and Quebec were enrolled and completed the baseline visit. Follow-up interviews are being conducted at 18-month intervals. Of the 1422 participants at baseline, 356 were from BC (25%), 713 from Ontario (50%), 353 from Quebec (25%). The median age of the participants at baseline was 43 years (range, 16-74). 22% identified as Indigenous, 30% as African, Caribbean or Black, 41% as Caucasian/White, and 7% as other ethnicities. Overall, 83% of women were taking antiretroviral therapy at the time of the baseline interview and of them, 87% reported an undetectable viral load. Of the 1326 women who received HIV medical care in the previous year and responded to corresponding questions, 57% (95% CI: 54%-60%) perceived that the care they received from their primary HIV doctor had been women-centred. There were provincial and age differences among women who indicated that they received WCHC versus not; women from BC or Ontario were more likely to report WCHC compared to participants in Quebec. They were also more likely to be younger. CHIWOS will be an important tool to develop care models specific for women living with HIV. Moreover, CHIWOS is collecting extensive information on socio-demographics, social determinants of health, psychological factors, and sexual and reproductive health and offers an important platform to answer many relevant research questions for and with women living with HIV. Information on the cohort can be found on the study website (http://www.chiwos.ca).

Health-related quality of life of HIV infected adults with and without Visceral Leishmaniasis in Northwest Ethiopia

BACKGROUND

Health-related quality of life (HRQoL) is an important outcome measure among HIV infected patients receiving antiretroviral therapy (ART). When HIV infected patients coinfected with Visceral Leishmaniasis (VL) the problem become severe because VL accelerates HIV replication and disease progression. The impact of VL on the quality of life of HIV infected patients has not been studied. In this study in Ethiopia, we compared the quality of life of HIV infected patients with and without VL.

METHODS

A cross-sectional study was conducted from October 2015 to September 2016 in selected health centers and hospitals, in Northwest Ethiopia. Data on quality of life was collected by trained nurses. The instrument used to collect the data was the short Amharic version of the World Health Organization Quality of Life for HIV clients (WHOQoL-HIV). Depression was assessed using the validated version of Kessler scale. Data was entered and analyzed using SPSS version 20. Descriptive statistics, bivariate and multivariate linear regression model was used to summarize the results.

RESULTS

A total of 590 study participants were included in the study with response rate of 95%. Of the 590 patients included in our study 125 (21%) were HIV-VL coinfection. HIV-VL coinfected patients had a lower quality of life in all the domains as compared to HIV patients without VL. Depression was consistently and strongly associated with all the quality of life domains of both groups. Also, in HIV infected patients a longer duration in ART was associated with higher HRQoL domains except for the spiritual and level of independence domains. With regard to HIV-VL coinfected patients, a longer duration in ART was associated with psychological, spiritual and level of independence domains of HRQoL. Demographics, clinical, and treatment characteristics resulted few significant associations with HRQoL domains of both groups.

CONCLUSION

HIV-VL coinfected patients had a poor quality of life in all the domains of the WHOQoL-HIV instrument. Depression, duration of ART and education were strongly associated with the quality of life. Depression should be targeted for intervention to improve the quality of life.

Health-related quality of life among military HIV patients on antiretroviral therapy

OBJECTIVE

The aims of this study were: (i) to determine the factors associated with HRQOL at baseline in our cohort, and (ii) to evaluate if there are differences in baseline HRQOL measures by antiretroviral treatment.

METHODS

The Short Form 36 (SF-36) was administered between 2006 and 2010 among members of the United States HIV Natural History Study cohort (NHS), and participants who completed the SF-36 were included in the study. Physical component summary (PCS) and mental component summary (MCS) scores were computed based on standard algorithms. Multivariate linear regression models were constructed for PCS and MCS to estimate the association between selected variables and HRQOL scores.

RESULTS

Antiretroviral therapy (ART) was not independently associated with HRQOL scores. Factors associated with PCS were CD4+ count < 200 cells/mm3 (β = -5.84, 95% CI: -7.63, -4.06), mental comorbidity (β = -2.82, 95% CI: -3.79, -1.85), medical comorbidity (β = -2.51, 95% CI: -3.75, -1.27), AIDS diagnosis (β = -2.38, 95% CI: -3.79, -0.98). Others were gender, military rank, marital status, and age. Factors independently associated with MCS were CD4+ count < 200 cells/mm3 (β = -1.93, 95% CI: -3.85, -0.02), mental comorbidity (β = -6.25, 95% CI: -7.25, -5.25), age (β = 0.37, 95% CI: 0.14, 0.60), and being African American (β = 1.55, 95% CI: 0.63, 2.47).

CONCLUSION

Among military active duty and beneficiaries with HIV, modifiable factors associated with HRQOL measures included advanced HIV disease, and mental or medical comorbidity. Addressing these factors may improve quality of life of HIV-infected individuals in the NHS cohort.

Quality of life in an Italian cohort of people living with HIV in the era of combined antiretroviral therapy (Evidence from I.A.N.U.A. study-investigation on antiretroviral therapy)

The aims of this study were to assess the Health Related Quality of Life (HRQoL) of People Living with HIV/AIDS (PLWHA) who attend outpatient services in Genoa, Italy, and to evaluate the relationship between HRQoL and clinical factors, primarily: CD4+ cell count, viral load and HIV-Hepatitis C Virus (HCV) coinfection. A cross-sectional study was performed involving a sample of 943 consecutive patients. Firstly the EuroQol-Five Dimensions-Three Level (EQ-5D-3L) self-reported questionnaire was used to evaluate HRQoL, while socio-demographic information was collected using a separate self-administered questionnaire. Descriptive statistical analysis was then used to show the socio-demographic and clinical characteristics of the sample. Having characterized the sample, Pearson's correlation technique was used to assess the relationship between HRQoL and socio-demographic and clinical characteristics. Finally, multivariable linear regression was used to determine factors associated with HRQOL. The median EQ-Visual analogue scale (EQ-VAS) score was 75.4 (SD 18.4). We found statistically significant associations between the EQ-VAS score and age, coinfection with HCV+, education, other drugs taken over cART, hospitalization due to HIV and a CD4+ cell count <200 mm³ compared with CD4+ cell count >500 mm³. Factors independently associated with lower HRQoL were: older age, coinfection with HCV+, other drugs used in addition to cART, hospitalization due to HIV and CD4+ cell count <200 mm³ compared with CD4+ cell count >500 mm³.

Testing a model of health-related quality of life in women living with HIV infection

PURPOSE

The purpose of this secondary analysis was to test Ferrans et al.'s (J Nurs Scholarsh 37(4):336-342, 2005) revised model of health-related quality of life (HRQoL) (2005) modified from the Wilson and Cleary (J Am Med Assoc 273(1):59-65, 1995) model on women living with HIV. The primary aim was to test this model, examining the relations among the five central components (biological function, symptoms, functional status, general health perceptions, and HRQoL). The secondary aim was to explore the individual (age, children, race, marital status, education) and environmental (HIV-related stigma, social support) characteristics that may impact the main components of the model.

METHODS

This study employed a cross-sectional correlational design using baseline data from 178 women living with HIV/AIDS who participated in one of the two independent randomized controlled trials designed to enhance HIV medication adherence. Path analysis using structural equation modeling was used to examine the hypothesized multivariate relations proposed in the revised Wilson and Cleary (J Am Med Assoc 273(1):59-65, 1995) model of HRQoL.

RESULTS

While the revised model did not fit, exploratory post hoc modified models with a path from depressive symptoms to overall general health had an adequate model fit. Women with lower depressive symptoms (r = -.457, p < .01), lower HIV-related stigma (r = -.462, p < .01), higher social support (r = .413, p < .01), higher physical functioning (r = .350, p < .01), and higher general health perceptions (r = .537, p < .01) had higher overall HRQoL.

CONCLUSIONS

The results of this study have the potential to assist healthcare professionals in improving HRQoL for women living with HIV/AIDS.

Health-related quality of life and associated factors in people with HIV: an Irish cohort study

Background

Considering the chronic and debilitating nature of HIV infection, health-related quality of life (HRQoL) is an important patient-reported clinical outcome to better understand the effects of this infection and its treatment on patients’ lives. The purpose of this study was to assess the HRQoL and its association with sociodemographic, behavioural, clinical, nutrition-related factors and social support in an Irish HIV cohort.

Methods

A cross-sectional, prospective study using the Medical Outcomes Study HIV Health survey assessed the 10 dimensions of HRQoL and summarised as Physical Health Summary (PHS) and Mental Health Summary (MHS) scores. Participants were categorised as having good or poor PHS and MHS using the standardised mean score of 50. The variables independently associated with PHS and MHS were identified using multivariable logistic regression models.

Results

Overall, 521 participants completed the HRQoL questionnaire. The median (IQR) PHS and MHS scores were 56 (47–60) and 51 (41–58) respectively. All the covariate groups had lower MHS than PHS. Participants with symptoms of HIV reported the lowest median (IQR) PHS score 44.7 (32.–54.5) and MHS score 36.1 (28.6–48.4). Of the 10 dimensions of HRQoL, the lowest scores were for the energy level and general health. Symptoms of HIV, co-morbidities, social support, employment and ethnicity had independent association with both PHS and MHS. Gender, education, alcohol intake and HIV-complications were associated with PHS. Age, illicit drugs, BMI and malnutrition were associated with MHS. However, CD4 count and viral load were not independently associated with PHS and MHS in multivariable regression models.

Conclusion

Overall, HIV-infected people in this cohort had an average level of HRQoL. However, it is impaired in people with symptoms and co-morbidities, and not independently associated with CD4 and viral load. Alleviating HIV symptoms and preventing co-morbidities are important in managing HIV. Providing psychosocial supports for behaviour modification and return to work or exploring new opportunities will help to improve HRQoL. Healthcare providers and policy makers need to plan and implement programs to routinely assess the HRQoL in a systematic method to facilitate a holistic management of HIV.

Gender differences in disclosure concerns and HIV-related quality of life

HIV-related disclosure concerns are associated with higher rates of concealment and poorer well-being, including poorer health related HIV quality of life (HIV-QOL). Little research, however, has examined whether gender differences exist in the links between HIV disclosure concerns and HIV-QOL. We expected that disclosure concerns and gender would be associated with HIV-QOL, such that the relationship between disclosure concerns and poorer HIV-QOL to be stronger in women living with HIV (WLWH) than in men living with HIV (MLWH). One hundred and forty MLWH (n = 102) and WLWH (n = 38) completed an online questionnaire consisting of measures regarding their demographics, disclosure concerns (HIV-stigma scale), and HIV-QOL (HIV-AIDS-Targeted Quality of Life Instrument). Results suggested that more disclosure concerns were associated with poorer HIV-QOL, but in general, men and women did not differ in their levels of HIV-QOL. As expected, interactions emerged between gender and disclosure concerns such that disclosure concerns were associated with increased health worries and poorer sexual functioning for WLWH but not for MLWH. Interventions should acknowledge the differing needs and experiences of WLWH in order to improve HIV-QOL and increase longevity.

Quality of life and associated morbidities among elderly persons registered with the Family Health Strategy of Senador Guiomard in the state of Acre

Objectives: To verify the prevalence of a low quality of life and analyze the morbidities associated with such a condition among elderly persons registered with the Family Health Strategy of the municipality of Senador Guiomard. Method : A cross-sectional study was performed of elderly persons registered with the Family Health Strategy in the urban area of the municipality of Senador Guiomard in the state of Acre. A comparison between men and women regarding morbidities and quality of life was performed using Pearson's chi-squared test. The associations between the tertiles of quality of life and morbidities were estimated by odds ratio through multivariate logistic regression analysis. Results : There were differences between men and women in the reporting of hypertension (p=0.015), diabetes (p=0.033), in the psychological domain (p=0.009) and in total quality of life (<0.001). Elderly people classified in the lower tertile of the physical and social domains of quality of life were more likely to suffer from hypertension, cardiovascular disorders and anemia. Those in the lower tertile of the psychological domain were also more likely to suffer from hypertension, cardiovascular disorders and insomnia, as well as anemia. Elderly individuals in the lower overall tertile were more likely to suffer from hypertension, cardiovascular disorders, insomnia and anemia. No statistically significant associations were found for the environmental domain. Conclusion : The total quality of life and the physical, psychological and social domains of quality of life can be considered good indicators of the described morbidities among the elderly. The environmental domain, however, was not a useful indicator.

A reduced factor structure for the PROQOL-HIV questionnaire provided reliable indicators of health-related quality of life

OBJECTIVES

To identify a simplified factor structure for the PROQOL-human immunodeficiency virus (HIV) questionnaire to improve the measurement of the health-related quality of life (HRQL) of HIV-positive patients in clinical care and research settings.

STUDY DESIGN AND SETTING

HRQL data were collected using the eight-dimension PROQOL-HIV questionnaire from 2,537 patients (VESPA2 study). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) validated a simpler four-factor structure and assessed measurement invariance (MI). Multigroup analysis assessed the effect of sex, age, and antiretroviral therapy (ART) on the resulting factor scores. Correlations with symptom and Short Form (SF)-12 self-reports assessed convergent validity.

RESULTS

Item analysis, EFA, and CFAs confirmed the validity [comparative fit index (CFI), 0.948; root mean square error of approximation, 0.064] and reliability (α's ≥ 0.8) of four dimensions: physical health and symptoms, health concerns and mental distress, social and intimate relationships, and treatment-related impact. Strong MI was demonstrated across sex and age (decrease in CFI <0.01). A multiple-cause multiple-indicator model indicated that HRQL correlated as expected with sex, age, and the ART status. Correlations of HRQL, symptom reports, and SF-12 scores evidenced convergent validity criterion.

CONCLUSION

The simplified factor structure and scoring scheme for PROQOL-HIV will allow clinicians to monitor with greater reliability the HRQL of patients in clinical care and research settings.

The use of PROMIS and the RAND VSQ9 in chiropractic patients receiving care with the Webster Technique

INTRODUCTION

Our ongoing efforts to demonstrate effectiveness of care examined the quality of life (QoL) and patient satisfaction of chiropractic patients presenting for care in a PBRN.

METHODS

In addition to socio-demographic and clinical care information, we examined visit-specific satisfaction and QoL using the RAND VSQ and PROMIS-29, respectively.

RESULTS

Our study population was comprised of 126 subjects (average age = 39.68; 97 females). The majority of respondents presented with musculoskeletal complaints with an average mean duration of 7.188 years. The mean PROMIS-25 mean T Scores were: depression (47.80); pain interference (53.49); fatigue (51.02); physical function (49.02); satisfaction with social role (52.10); anxiety (50.14); and sleep disturbance (49.88). The VSQ9 mean score was 93.4% indicating high satisfaction.

CONCLUSIONS

Adults attending care in a chiropractic PBRN were able to successfully complete the PROMIS29 and VSQ9 instruments. Future longitudinal studies should quantify the minimal clinically important difference in mean T score changes.

Creating a Crosswalk to Estimate AIDS Clinical Trials Group Quality of Life Scores in a Nationally Representative Sample of Persons in Care for HIV in the United States

BACKGROUND

Optimizing health-related quality of life (HRQOL) is an increasingly important goal in the treatment of HIV/AIDS. Interpretation of HRQOL scores in clinical trials is enhanced by comparative data.

PURPOSE

To estimate AIDS Clinical Trials Group (ACTG) QOL 601-602 questionnaire scale scores for a nationally representative sample of persons in care for HIV.

METHOD

The study cohort was from the HIV Cost and Services Utilization Study (HCSUS), a multistage national probability sample. We derived HCSUS HRQOL scale scores from the items shared between the ACTG QOL 601-602 and HCSUS HRQOL questionnaires using regression equations. Cronbach's alpha coefficient was used to estimate the reliability of the multi-item scales in the ACTG QOL 601-602 and HCSUS HRQOL instruments. Correlation Coefficients and R2s of regression models were calculated to determine the concordance of the models. Multiple regression was used to determine if patient characteristics accounted for differences (residuals) between scores observed from the full HCSUS HRQOL instruments and scores predicted using the subset of shared items in ACTG QOL 601-2.

RESULTS

Internal consistency reliability estimates were acceptable (>0.70) for all scales in the ACTG QOL 601-602 and HCSUS HRQOL instruments. Correlations between corresponding ACTG QOL 601-602 and HCSUS HRQOL scale scores were high (>0.9). The R2s for predicting HCSUS HRQOL scores from the ACTG QOL 601-602 scales were also high (>0.8). For physical functioning, emotional well-being, and general health perceptions, the predictors of differences (residuals) in observed and predicted HCSUS HRQOL scores were gender and CDC stage of HIV infection (P < .05).

CONCLUSION

This study provides normative data from the US HIV/AIDS population for comparison to the ACTG QOL 601-602 questionnaire. Accuracy of estimation is enhanced if done separately by gender and HIV disease stage.

Gender differences in health related quality of life among people living with HIV on highly active antiretroviral therapy in Mekelle Town, Northern Ethiopia

Background. Health related quality of life (HRQOL) is an important outcome measure for highly active antiretroviral treatment program. In Ethiopia, studies revealed that there are improved qualities of life among adults living with the viruses taking antiretroviral therapy but there is no explicit data showing gender differences in health related quality of life. Aim. To assess gender differences in HRQOL and its associated factors among people living with HIV and on highly active antiretroviral therapy in public health institutions of Mekelle town, Northern Ethiopia. Methods. A comparative cross-sectional study was conducted among 494 adult people living with HIV taking ART services. Quality of life was measured using WHOQOL-HIV BREF. Result. There was a statistically significant gender difference (P < 0.05) in HRQOL among PLHIV on HAART. Females had low score in all HRQOL domains. High perceived stigma was strongly associated with poor psychological quality of domain among both female and male groups with [AOR = 2.89(1.69,4.96)] and [AOR = 2.5(1.4,4.4)], respectively. Conclusion. There was statistically significant gender difference in all quality of life domains. Public health interventions to improve HRQOL of PLHIV should take in to account the physical, psychological, social, environmental, and spiritual health of PLHIV during treatment, care, and support.

What determines health-related quality of life among people living with HIV: an updated review of the literature

BACKGROUND

As infection with the Human Immunodeficiency Virus (HIV) has evolved to a chronic disease, perceived health-related quality of life (HRQoL) is becoming a prominent and important patient-reported outcome measure in HIV care. Literature discusses different factors influencing HRQoL in this population, however, currently no consensus exists about the main determinants. In this review a clear, up-to-date overview of the determinants influencing HRQOL among people living with HIV is provided.

METHODS

All studies published before July 2013 that identified determinants of HRQoL among people living with HIV in high-income countries, were considered in this narrative review. PubMed, Web of Science and The Cochrane Library were consulted using the keywords 'determinants', 'quality of life', 'HIV' and 'AIDS'. To be included, studies should have reported overall health and/or physical/mental health scores on a validated instrument and performed multivariable regression analyses to identify determinants that independently influence perceived HRQoL.

RESULTS

In total, 49 studies were included for further analysis and they used a variety of HRQoL instruments: Medical Outcomes Study Short Form-36 or variants, Medical Outcomes Study-HIV, HIV Cost and Services Utilization Study measure, Multidimensional Quality of Life Questionnaire, HIV targeted quality of life instrument, Functional Assessment of Human Immunodeficiency Virus Infection, HIV Overview of Problems Evaluation System, EuroQol, Fanning Quality of Life scale, Health Index and PROQOL-HIV. In this review, the discussed determinants were thematically divided into socio-demographic, clinical, psychological and behavioural factors. Employment, immunological status, presence of symptoms, depression, social support and adherence to antiretroviral therapy were most frequently and consistently reported to be associated with HRQoL among people living with HIV.

CONCLUSIONS

HRQoL among people living with HIV is influenced by several determinants. These determinants independently, but simultaneously impact perceived HRQoL. Most HRQoL instruments do not capture all key determinants. We recommend that the choice for an instrument should depend on the purpose of the HRQoL assessment.

Factors influencing the diabetes-specific health-related quality of life in children and adolescents with type 1 diabetes mellitus

This study aimed to investigate the association of the anthropometric, clinical variables and maximal oxygen uptake (Vo2max) with diabetes-specific health-related quality of life (HRQoL) in youths with type 1 diabetes mellitus (T1DM) and to find the predictors of HRQoL and blood glucose control. A total of 239 youths with diabetes (124 boys and 115 girls) were recruited from diabetes-based summer camps. HRQoL assessment was carried out with the Pediatric Quality of Life Inventory 3.0 Diabetes Module (Information Resources Centre, Mapi Research Trust, France); Vo2max was evaluated by conducting the 20-m shuttle run test. Higher Vo2max and the insulin pump therapy were significant predictors of the HRQoL in the multiple regression analysis; other clinical and anthropometric variables had no effect. The better blood glucose control was explained only by the higher Vo2max. The good cardiorespiratory fitness (expressed by Vo2max) has clinical and QoL benefits for paediatric patients with T1DM.

Improvements in depression and changes in quality of life among HIV-infected adults

Improving quality of life (QOL) for HIV-infected individuals is an important objective of HIV care, given the considerable physical and emotional burden associated with living with HIV. Although worse QOL has been associated with depression, no research has quantified the potential of improvement in depression to prospectively improve QOL among HIV-infected adults. We analyzed data from 115 HIV-infected adults with depression enrolled in a randomized controlled trial to evaluate the effectiveness of improved depression care on antiretroviral drug adherence. Improvement in depression, the exposure of interest, was defined as the relative change in depression at six months compared to baseline and categorized as full response (≥50% improvement), partial response (25-49% improvement), and no response (<25% improvement). Multivariable linear regression was used to investigate the relationship between improvement in depression and four continuous measures of QOL at six months: physical QOL, mental QOL, HIV symptoms, and fatigue intensity. In multivariable analyses, physical QOL was higher among partial responders (mean difference [MD] = 2.51, 95% CI: -1.51, 6.54) and full responders (MD = 3.68, 95% CI: -0.36, 7.72) compared to individuals who did not respond. Mental QOL was an average of 4.01 points higher (95% CI: -1.01, 9.03) among partial responders and 14.34 points higher (95% CI: 9.42, 19.25) among full responders. HIV symptoms were lower for partial responders (MD = -0.69; 95% CI: -1.69, 0.30) and full responders (MD = -1.51; 95% CI: -2.50, -0.53). Fatigue intensity was also lower for partial responders (MD = -0.94; 95% CI: -1.94, 0.07) and full responders (MD = -3.00; 95% CI: -3.98, -2.02). Among HIV-infected adults with depression, improving access to high-quality depression treatment may also improve important QOL outcomes.

Health-related quality of life dynamics of HIV-positive South African women up to ART initiation: evidence from the CAPRISA 002 acute infection cohort study

Few studies have investigated the long-term dynamics in health-related quality of life (HRQoL) among HIV-positive persons from acute infection. From 2004, 160 women were enrolled into the CAPRISA 002 Acute Infection study at two sites in the province of KwaZulu-Natal and underwent 3-6 monthly HRQoL assessments using the functional assessment of HIV infection (FAHI) instrument. Overall and 5 sub-scale FAHI scores [physical well-being (PWB), emotional well-being (EWB), functional and global well-being (FGWB), social well-being (SWB) and cognitive functioning (CF)] were calculated up to antiretroviral therapy (ART) initiation and scores at enrollment were compared to the acute, early and established infection phases. Mixed-effects regression models adjusting for behavioral and clinical factors were applied to assess HRQoL trends and the proportion of women meeting minimally important differences was calculated. Our analyses revealed that overall/sub-scale scores improved over time, except from PWB and CF. A higher educational status, contraceptive use and a higher BMI were the strongest predictors of higher overall/sub-scale FAHI scores. CD4 count and HIV viral load were strongly associated with PWB and CF, but not overall FAHI and other sub-scales. Women newly diagnosed with acute HIV infection face profound HRQoL challenges. While early ART delivery may be important for PWB and CF, factors such as education, contraception provision and good nutritional status should be promoted to maximize HRQoL in HIV positive individuals.

A systematic review of cohort studies of the quality of life in HIV/AIDS patients after antiretroviral therapy

The aim of this paper was to review cohort studies that analyze changes in the quality of life of people living with HIV/AIDS. We searched the PubMed and EmBase databases from inception to December 2012 for primary cohort studies of the quality of life of people living with HIV/AIDS after combination antiretroviral therapy (cART). Two independent reviewers screened and selected published studies of quality of life that had been followed up for more than 12 weeks after the beginning of cART. Data from the papers were analyzed to identify common characteristics of the effects of cART on the quality of life of HIV/AIDS patients. Eight cohort studies were found: only four were assessed as high quality and four were assessed as moderate quality. None of the studies described patient selection. Six studies followed the patients for one year or more, and the other studies for less than 6 months. Seven studies reported quality of life had been improved after initiation of cART, and one study reported no change. Previous research suggested that cART improved the quality of life of AIDS patients for a limited time, so further research for longer periods is needed to confirm this outcome.

The influence of psychological variables on health-related quality of life among HIV-positive individuals with a history of intravenous drug use

OBJECTIVE

Intravenous drug use (IDU) remains a prominent pathway of HIV transmission in the United States, though little is known about modifiable factors influencing quality of life among IDUs. The goal of this study was to evaluate the influence of psychological variables (e.g., depression and anxiety) on health-related quality of life among HIV-positive individuals with a history of IDU who were enrolled in outpatient treatment for opioid dependence.

METHOD

108 HIV-positive individuals with a history of IDU and participating in current outpatient treatment for opiate dependence who were screened for participation in a depression and adherence study reported sociodemographic data, depressive and anxiety symptoms, and health-related quality of life (HRQoL; Multidimensional Health Assessment using the ACTG-SF 21).

RESULTS

Multiple regression models controlling for disease stage and background characteristics identified significant negative relationships between General Health Perception and Functioning without Pain for anxiety and depression, and between Role Functioning and Physical Functioning for anxiety. CD4 cell count was significantly related to Physical Functioning only.

CONCLUSIONS

Results indicate that distress (both depression and anxiety) contribute significantly to variation in HRQoL over and above the effects of disease variables. Effective depression and anxiety treatment may result in improved overall functioning.