1
|
Foroozanfar Z, Hooshyar D, Joulaei H. Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran. Qual Life Res 2024:10.1007/s11136-023-03586-9. [PMID: 38231437 DOI: 10.1007/s11136-023-03586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE We aimed to assess psychosocial predictors of quality of life (QOL) among women living with HIV/AIDS (WLHIV). QOL has been considered as an important indicator in evaluating the outcome of psychological and physical healthcare in people living with HIV (PLHIV). METHODS This cross-sectional study was carried out from October 2021 to April 2022 at the Voluntary, Counselling, and Testing (VCT) center in Shiraz, Iran. A total of 452 WLHIV were included in this study. Socio-demographic and clinical data, social support (MSPSS questionnaire), food insecurity (HFIAS questionnaire), resilience (CD-RISC questionnaire), mental health status (DASS questionnaire), and QOL (WHOQOL-BREF questionnaire) were collected through direct interviews and patients' files at Shiraz VCT. RESULTS Physical and social relationships domains of QOL had the highest (60.48 ± 18.00) and lowest (36.76 ± 23.88) scores, respectively. Higher clinical stage, psychotropic substances use, having a husband infected with HIV, history of hypertension, and higher socioeconomic status had a significant relationship with some domains of QOL. The score of social support, food insecurity, resilience, and mental health status had a significant relationship with all domains of QOL. CONCLUSION Social relationships domain of QOL had the lowest scores in WLHIV. Also, the mental health status of WLHIV was more related to their QOL than the physical status related to HIV/AIDS. Interventions such as improving the mental health care and resilience skills of WLHIV, including their social network in counseling services to promote their social support, could help them to improve their QOL.
Collapse
Affiliation(s)
- Zohre Foroozanfar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Hooshyar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran.
| |
Collapse
|
2
|
Ken-Opurum J, Prajapati G, Matos JE, Goswami S, Kumar P. Body mass index and quality of life in people living with HIV. AIDS Care 2023; 35:1542-1554. [PMID: 36912678 DOI: 10.1080/09540121.2023.2185195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Abstract
With advances in the treatment of HIV, people living with HIV (PLWH) are now expected to have a near-normal life expectancy, but challenges remain in the form of substantially poorer health-related quality of life (HRQoL) than the general population. Being overweight or obese may pose an additional burden in PLWH, but few studies have evaluated the relationship between body mass index (BMI) and HRQoL in PLWH. This study aimed to evaluate and describe the association between HRQoL and BMI among PLWH in the US. Data were obtained from the 2018 and 2019 US National Health and Wellness Survey, an online, self-reported, general population survey. Analyses included 575 PLWH who self-reported a physician diagnosis and prescription use for the treatment of HIV, as well as 1725 propensity score matched non-HIV controls. After adjusting for age, sex, race, and comorbidities, higher BMI was associated with poorer physical (β = -0.18, p = 0.005) and general (β = -0.42, p = 0.014) HRQoL among PLWH. Additionally, PLWH reported poorer mental, physical, and general HRQoL than non-HIV controls; these relationships were not moderated by BMI. The potential negative impact of higher BMI on patients' humanistic outcomes should be considered in HIV management, including selection of treatment.
Collapse
Affiliation(s)
| | | | | | | | - Princy Kumar
- Georgetown University Medical Center, Washington DC, USA
| |
Collapse
|
3
|
Abdulai M, Owiredu D, Boadu I, Tabong PTN, Sarfo B, Bonful HA, Addo- Lartey A, Akuffo KO, Danso-Appiah A. Psychosocial interventions and their effectiveness on quality of life among elderly persons living with HIV in Africa South of the Sahara: Systematic review and meta -analysis protocol. PLoS One 2023; 18:e0291781. [PMID: 37729324 PMCID: PMC10511069 DOI: 10.1371/journal.pone.0291781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The number of elderly people living with HIV (EPLHIV) has increased significantly as a result of antiretroviral treatment (ART) and this has brought about a variety of psychosocial challenges that have an impact on their quality of life (QoL). Various psychosocial interventions have been tried or implemented in Sub-Saharan Africa (SSA) to improve QoL of EPLHIV. However, there is paucity of data on the types and effectiveness of these interventions. This systematic review, therefore, aims to explore available psychosocial interventions in SSA and their effectiveness in improving the QoL of EPLHIV. METHODS We will search PubMed, PsycINFO, LILACS, Cochrane Library, Google Scholar, HINARI, Africa Journals Online, Scopus and Web of Science to retrieve publications on psychosocial interventions implemented to improve QoL of EPLHIV from inception of the identified databases to 31st December 2023 without language restrictions. Also, supplementary sources such as conference proceedings, preprint repositories, databases of dissertations, as well as WHO and governmental databases can be explored for additional studies. For unpublished studies, trial registries and experts would be contacted, and reference lists of retrieved papers will be manually searched. Retrieved studies will be deduplicated using Mendeley and exported to Rayyan. At least two reviewers will independently select studies, extract data and assess the quality of the included studies using validated tools. Dichotomous outcomes data will be assessed and reported as odds ratio (OR) or risk ratio (RR) and for continuous outcomes, mean difference (MD) will be used; all reported with their 95% confidence interval (CI). Heterogeneity will be explored graphically by inspecting the overlapping of CIs and assessed quantitatively using the I2 statistic. EXPECTED OUTCOMES This systematic review will be the first to rigorously identify psychosocial intervention on QoL of EPLHIV in SSA and assess their effectiveness with the aim to provide regional and country- specific data that will inform the selection and implementation of appropriate and socially acceptable policies across countries in SSA. Key findings of the review are expected to contribute critical evidence on availability, types and effectiveness of psychosocial interventions for improving quality of life of vulnerable elderly persons in SSA living with HIV. Furthermore, the review will explore any variation and possible correlates of psychosocial interventions by age, sex, CD4 count (if available), setting and geographic location within SSA that will provide healthcare professionals with reliable evidence, with the ultimate goal of inspiring countries in SSA to adopt innovative interventions to improve HIV care. TRIAL REGISTRATION Systematic review registration: The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO), with registration ID CRD42021278218.
Collapse
Affiliation(s)
- Marijanatu Abdulai
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- National AIDS/STI Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - David Owiredu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Isaac Boadu
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Science, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Adolphina Addo- Lartey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Accra, Ghana
| |
Collapse
|
4
|
Slama L, Porcher R, Linard F, Chakvetadze C, Cros A, Carillon S, Gallardo L, Viard JP, Molina JM. Injectable long acting antiretroviral for HIV treatment and prevention: perspectives of potential users. BMC Infect Dis 2023; 23:98. [PMID: 36803606 PMCID: PMC9936705 DOI: 10.1186/s12879-023-08071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/09/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The use of long acting injectable (LAA) antiretroviral drugs may be an alternative option for HIV treatment and prevention. Our study focused on patient perspectives to understand which individuals, among people with HIV (PWH) and pre-exposure prophylaxis (PrEP) users, would constitute the preferential target for such treatments in terms of expectations, tolerability, adherence and quality of life. METHODS The study consisted in one self-administrated questionnaire. Data collected included lifestyle issues, medical history, perceived benefits and inconveniences of LAA. Groups were compared using Wilcoxon rank tests or Fisher's exact test. RESULTS In 2018, 100 PWH and 100 PrEP users were enrolled. Overall, 74% of PWH and 89% of PrEP users expressed interest for LAA with a significantly higher rate for PrEP users (p = 0.001). No characteristics were associated with acceptance of LAA in both groups in term of demographics, lifestyle or comorbidities. CONCLUSION PWH and PrEP users expressed a high level of interest in LAA, since a large majority seems to be in favor of this new approach. Further studies should be conducted to better characterize targeted individuals.
Collapse
Affiliation(s)
- Laurence Slama
- Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004, Paris, France. .,Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France.
| | - Raphael Porcher
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004 Paris, France ,grid.411394.a0000 0001 2191 1995Centre d’Épidémiologie Clinique, AP-HP, Hôtel-Dieu, 75004 Paris, France
| | - Françoise Linard
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,Department of Infectious Diseases, Tenon Hospital, APHP, 75020 Paris, France
| | - Catherine Chakvetadze
- Departement of Infectious Diseases, Groupe Hospitalier Sud Île de France, Melun, France
| | - Agnès Cros
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,COREVIH Île de France Sud, Créteil, France
| | | | - Lucille Gallardo
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,Mesopolhis, AMU/IEP, Aix-en-Provence, France
| | - Jean-Paul Viard
- grid.411394.a0000 0001 2191 1995Department of Infectious Diseases, Hôtel Dieu Hospital, APHP, 1 Place du Parvis Notre-Dame, 75004 Paris, France ,Paris Cité University, Paris, France
| | - Jean-Michel Molina
- grid.50550.350000 0001 2175 4109Departement of Infectious Diseases, Saint Louis and Lariboisière Hospitals, APHP, Paris, France ,grid.7429.80000000121866389INSERM U944, Paris, France
| |
Collapse
|
5
|
Health related quality of life of HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia: Evidence from a cross-sectional study. Heliyon 2023; 9:e13318. [PMID: 36747523 PMCID: PMC9898445 DOI: 10.1016/j.heliyon.2023.e13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
Background Evidence revealed that there is a statistically significant gender difference in Health-related quality of life (HRQoL) among HIV-positive people on Antiretroviral therapy (ART). Consequently, HIV-positive women have low scores in all HRQoL domains than men. Despite this fact, previous studies in Ethiopia focused on general HIV-positive people and paid less attention to HIV-positive women. Therefore, this study was intended to measure HRQoL and associated factors among HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia. Methods An institution-based cross-sectional study was conducted from February 01-April 30, 2022. Four hundred twenty-six women on ART were included using a systematic random sampling technique. Face-to-face interviews and medical record reviews were used to collect data. Both bivariable and multiple linear regressions were computed to identify the factors associated with HRQoL. A p-value <0.05 was used to assert statistically significant variables in multiple linear regression analysis. Results The overall mean (SD) score of the HRQoL was 11.84 (2.44). And, 44.7% [95% CI: 40.3, 49.5] of the women have poor HRQoL. In multiple linear regression analysis, factors like depression (β = -0.35), Post-Traumatic Stress Disorder (PTSD) (β = -0.16), age (β = -0.07), rural residence (β = -0.52), and bedridden functional status (β = -1.02) were inversely associated with HRQoL. Oppositely, good treatment adherence (β = 0.46) was positively associated with overall HRQoL, keeping other factors constant. Conclusion This study reveals a high magnitude of poor HRQoL among HIV-positive women. Therefore, as HRQoL domains are comprehensive indicators of living status, healthcare service providers should be dedicated to screening and supporting HIV-positive women with poor HRQoL. Additionally, healthcare providers should also pay special attention to routine PTSD screening and management for HIV-positive women due to its detrimental effect on HRQoL.
Collapse
|
6
|
Harris RM, Xavier Hall CD, Mills JC, Pence BW, Bgneris J, Wong FY. Beyond Viral Suppression-The Impact of Cumulative Violence on Health-Related Quality of Life Among a Cohort of Virally Suppressed Patients. J Acquir Immune Defic Syndr 2023; 92:59-66. [PMID: 36099083 PMCID: PMC11079852 DOI: 10.1097/qai.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV. DESIGN We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 ( n = 284). METHODS A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress. RESULTS The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms ( P <0.001), increased depressive symptoms ( P <0.001), and increased HIV symptom distress ( P < 0.01). HIV symptom distress displayed the largest association with HRQoL ( P < 0.001), followed by depressive symptoms ( P = 0.001) and PTSD symptoms ( P < 0.001). These factors explained approximately 51% of the variance in HRQoL ( R2 = 0.51, P < 0.001). CONCLUSIONS Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable.
Collapse
Affiliation(s)
- Rachel M Harris
- Center for Population Sciences and Health Equity College of Social Work, Florida State University, FL
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Center for Population Sciences and Health Equity, Northwestern University, Florida State University, FL
| | - Jon C Mills
- College of Medicine, Center for Population Sciences and Health Equity, Florida State University, FL
| | - Brian W Pence
- Gillings School of Global Public Health, University of North Carolina, Chape Hill, NC
| | - Jessica Bgneris
- Center for Population Sciences and Health Equity, Graduate College of Social Work, Florida State University, University of Houston, TX; and
| | - Frankie Y Wong
- Center for Population Sciences and Health Equity, Florida State University, FL
| |
Collapse
|
7
|
Bradley H, Zhu Y, Duan X, Kang H, Qu B. HIV-Specific Reported Outcome Measures: Systematic Review of Psychometric Properties. JMIR Public Health Surveill 2022; 8:e39015. [PMID: 36222289 PMCID: PMC9782451 DOI: 10.2196/39015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The management of people living with HIV and AIDS is multidimensional and complex. Using patient-reported outcome measures (PROMs) has been increasingly recognized to be the key factor for providing patient-centered health care to meet the lifelong needs of people living with HIV and AIDS from diagnosis to death. However, there is currently no consensus on a PROM recommended for health care providers and researchers to assess health outcomes in people living with HIV and AIDS. OBJECTIVE The purpose of this systematic review was to summarize and categorize the available validated HIV-specific PROMs in adults living with HIV and AIDS and to assess these PROMs using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. METHODS This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of 3 recommended databases (PubMed, Embase, and PsychINFO) was conducted on January 15, 2021. Studies were included if they assessed any psychometric property of HIV-specific PROMs in adults living with HIV and AIDS and met the eligibility criteria. The PROMs were assessed for 9 psychometric properties, evaluated in each included study following the COSMIN methodology by assessing the following: the methodological quality assessed using the COSMIN risk of bias checklist; overall rating of results; level of evidence assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation approach; and level of recommendation. RESULTS A total of 88 PROMs classified into 8 categories, assessing the psychometric properties of PROMs for adults living with HIV and AIDS, were identified in 152 studies including 79,213 people living with HIV and AIDS. The psychometric properties of most included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation were the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the Adult AIDS Clinical Trial Group, and People Living with HIV Resilience Scale. In addition, because of a lack of evidence, recommendations regarding use could not be made for most of the remaining assessed PROMs (received class B recommendation). CONCLUSIONS This systematic review recommends 3 PROMs to assess health outcomes in adults living with HIV and AIDS. However, all these PROMs have some shortcomings. In addition, most of the included PROMs do not have sufficient evidence for assessing their psychometric properties and require a more comprehensive validation of the psychometric properties in the future to provide more scientific evidence. Thus, our findings may provide a reference for the selection of high-quality HIV-specific PROMs by health care providers and researchers for clinical practice and research.
Collapse
Affiliation(s)
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Xiyu Duan
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Hao Kang
- Administration Department of Nosocomial Infection, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China.,School of Public Health, China Medical University, Shenyang, China
| |
Collapse
|
8
|
Antela A, Bernardino JI, de Quirós JCLB, Bachiller P, Fuster-RuizdeApodaca MJ, Puig J, Rodríguez S, Castrejón I, Álvarez B, Hermenegildo M. Patient-Reported Outcomes (PROs) in HIV Infection: Points to Consider and Challenges. Infect Dis Ther 2022; 11:2017-2033. [PMID: 36066841 DOI: 10.1007/s40121-022-00678-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of this study was to reach consensus on the use of PROs (patient-reported outcome measures) in people living with HIV (PLHIV). METHODS A scientific committee of professionals with experience in PROMs methodology issued recommendations and defined the points to support by evidence. A systematic review of the literature identified the coverage, utility, and psychometric properties of PROMs used in PLHIV. A Delphi survey was launched to measure the degree of agreement with the recommendations of a group of practicing clinicians and a group of patient representatives. RESULTS Four principles and ten recommendations were issued; however, the results of the Delphi showed significant differences in the opinion between health professionals and PLHIV, and polarization within collectives, hampering consensus. CONCLUSIONS Despite a wealth of evidence on the benefit of PROMs, there are clear barriers to their use by healthcare professionals in HIV care. Intervention on these barriers is paramount to allow truly patient-centered care.
Collapse
Affiliation(s)
- Antonio Antela
- Infectious Diseases Unit, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain.
| | | | | | - Pablo Bachiller
- Internal Medicine Department, Complejo Asistencial de Segovia, Segovia, Spain
| | | | - Jordi Puig
- Hospital Universitario Germans Trias I Pujol, Fundació Lluita Contra La Sida I Les Malalties Infeccioses, Badalona, Spain
| | | | - Isabel Castrejón
- Rheumatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Beatriz Álvarez
- HIV and Infectious Diseases Unit, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | |
Collapse
|
9
|
Nshimirimana C, Ndayizeye A, Smekens T, Vuylsteke B. Loss to follow-up of patients in HIV care in Burundi: A retrospective cohort study. Trop Med Int Health 2022; 27:574-582. [PMID: 35411666 DOI: 10.1111/tmi.13753] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective was to assess the loss to follow-up (LTFU) rates and associated factors amongst patients in HIV care in Burundi. METHODS We conducted a retrospective cohort study in HIV-positive patients aged ≥15 years who started antiretroviral therapy (ART) between January 2015 and July 2020, with 31 December 2020 as the end point. The outcome of LTFU was defined as failure of a patient to report for drug refill within 90 days from the last appointment. Study data were extracted from the national AIDS Info database. The LTFU proportion was determined using the Kaplan-Meier method with the log-rank test, whereas LTFU risk factors were explored using the Cox regression model. RESULTS A total of 29,829 patients on ART were included in the analysis. Cumulative incidence of LTFU was 2.3% at 12 months, 6.5% at 24 months, 12.7% at 36 months, 19.0% at 48 months, 24.1% at 60 months and 25.3% at 72 months. The overall LTFU incidence rate was 11.2 per 100 person-years of observation. The risk of LTFU was higher amongst patients who started ART after 2016 (adjusted hazard ratio [aHR] 1.75, 95% confidence interval [CI] 1.65-1.85) or within 7 days after diagnosis (aHR 1.27, 95% CI 1.21-1.35). CONCLUSION Our findings demonstrate the relatively high incidence of LTFU in the Burundi HIV programme. Interventions targeting patients with risk factors for LTFU are particularly necessary.
Collapse
Affiliation(s)
| | - Aimé Ndayizeye
- HIV/STIs Burundi National Program, Ministry of Public Health, Bujumbura, Burundi
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
10
|
Öz Ö, Argon A, Kebat T, Namlı Akıncı Ç, Özdemir Ö. The Significance of Tumor Budding and Immunohistochemical Axl Expression in Gallbladder Adenocarcinomas. Balkan Med J 2022; 39:199-208. [PMID: 35430785 PMCID: PMC9136546 DOI: 10.4274/balkanmedj.galenos.2022.2021-9-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Tumor budding is a histopathological finding that is accepted as an indicator of epithelial-mesenchymal transformation in many solid tumors. Axl is a Receptor Tyrosine Kinase (RTK) family member and contributes to epithelial-mesenchymal transformation. It has been reported that its overexpression in various solid cancer cells is associated with a poor prognosis. It is claimed that Axl RTK may be the targeted molecule in treating some cancers due to its location in the cell membrane. Aims: To investigate the relationship between immunohistochemical (IHC) Axl expression with tumor budding on the histopathological level and their prognostic significance in patients with gallbladder carcinoma. Thus, it is aimed to contribute to the emergence of a molecular option for targeted, personalized therapy in these patients. Study Design: A retrospective cross-sectional study. Methods: Thirty-eight gallbladder cancer patients who underwent surgery between 2000 and 2017 were included in the study. The expressions of Axl RTK in tumor tissues were evaluated by the IHC method. Demographic data (age, sex) of patients, histopathological features (size, growth pattern), tumor differentiation, pathological T staging, lymphovascular invasion, perineural and serosal invasion, surgical margin, tumor infiltrated lymphocyte, and tumor budding were examined. The tumor budding of the tumor was made according to the International Tumor Budding Consensus Conference and was classified as low (0-4 buds), intermediate (5-9 buds), high (≥ 10 buds). The relationship between clinical pathologic features, the survival rate, and Axl expression was analyzed with Person’s chi-square, Cox regression tests, and the Kaplan-Meier method. Results: Tumor budding was determined as low in 12, intermediate in 10, and high in 16 cases. The increased degree of tumor budding was associated with focal-diffuse Axl expression (p = 0.018), infiltrative growth patterns (p = 0.031), poor differentiation (p = 0.006), advanced pathological stage (p = 0.002), and serosal (p = 0.040), perineural (p = 0.008), and lymphovascular invasion (p < 0.0001). Overall survival time was shorter in patients with intermediate to high tumor budding compared with those with low tumor budding (p = 0.011). Conclusion: Axl expression appears to be associated with tumor budding capacity, which may be a poor prognostic criterion for patients with gallbladder cancer. It may be a good target to prevent tumor budding to reduce tumor invasion and metastasis.
Collapse
Affiliation(s)
- Özden Öz
- Clinic of Pathology, University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Asuman Argon
- Clinic of Pathology, University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Tulu Kebat
- Clinic of Pathology, University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Çisem Namlı Akıncı
- Clinic of Pathology, University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Özlem Özdemir
- Clinic of Oncology, University of Health Sciences Turkey, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
11
|
Narváez M, Lins-Kusterer L, Valdelamar-Jiménez J, Brites C. Quality of Life and Antiretroviral Therapy Adherence: A Cross-Sectional Study in Colombia. AIDS Res Hum Retroviruses 2022; 38:660-669. [PMID: 35459414 DOI: 10.1089/aid.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The introduction of highly active combined antiretroviral therapy (cART) has changed the management of HIV/AIDS, which is recognized as a chronic disease with relevant aspects, such as adherence and quality of life. This study aimed to compare clinical and demographic characteristics and health-related quality of life in people with adherence and non-adherence to cART. A cross-sectional study was carried out with 200 participants. The instruments used were the Adherence Follow-up Questionnaire, the Beck Depression Inventory-II, the 36-Item Short Form Health Survey and the WHOQOL-HIV BREF. Poisson regression was applied to obtain estimates of adjusted prevalence ratios (PRadj). Individuals lacking therapeutic support were more likely to be non-adherent than those with proper support (PR: 1.79). The health-related quality of life of individuals with non-adherence was 4% lower (PR = 0.96) in the general health domain than individuals with adherence. Non-adherence to cART was associated with lower quality of life in the general health domain and no therapeutic support.
Collapse
Affiliation(s)
- Mónica Narváez
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Liliane Lins-Kusterer
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Juliet Valdelamar-Jiménez
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Carlos Brites
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
12
|
Mokgethi NO, Christofides N, Machisa M, Akpomiemie G, Lalla-Edward S. Quality of life and associated factors among people receiving second-line anti-retroviral therapy in Johannesburg, South Africa. BMC Infect Dis 2022; 22:456. [PMID: 35550020 PMCID: PMC9103409 DOI: 10.1186/s12879-022-07429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Studies which examine quality of life (QOL) provide important insights that are needed to understand the impacts of HIV/AIDS anti-retroviral treatment (ART), comorbid conditions and other factors on the daily activities of people living with HIV/AIDS (PLH). This study aimed to determine the inter-relationships between clinical factors, behavioural, socio-demographic variables and QOL among PLH. Methods The secondary analysis used data collected from 293 people living with HIV/AIDS (PLH) receiving second-line ART in Johannesburg in a clinical trial which evaluated the non-inferiority of ritonavir-boosted darunavir (DRV/r 400/100 mg) compared to ritonavir-boosted lopinavir (LPV/r) over a 48 week-period. Physical functioning, cognitive and mental QOL were measured using the Aids Clinical Trial Group questionnaire. Exploratory factor analyses were used to examine the structure, the relationships between and the construct validity of QOL items. Structural equation models which tested the a priori-hypothesised inter-relationships between QOL and other variables were estimated and goodness of fit of the models to the data was assessed. Results Patients on darunavir presented with lower pill burden. Older patients and women were more likely to report lower QOL scores. Pill burden mediated the effects of age, sex and treatment regimen on physical functioning QOL and adverse effects; the effects of age, sex, treatment regimen and adverse effects on cognitive QOL; and the effects of sex on mental QOL. Conclusion QOL among PLH is associated with socio-demographic and clinical factors. Therefore, QOL could be enhanced by considering PLH characteristics, clinical factors such as regimen side-effects profile, management of comorbid conditions and mitigating risks such as potential adverse drug-to-drug interactions among patients on ART. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07429-9.
Collapse
Affiliation(s)
- Nomcebo Oratile Mokgethi
- Epidemiology and Biostatistics, WHO, Bloemfontein, Free State, South Africa. .,School of Public Health, Wits University, Johannesburg, South Africa. .,Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | | | - Mercilene Machisa
- School of Public Health, Wits University, Johannesburg, South Africa.,Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Godspower Akpomiemie
- School of Public Health, Wits University, Johannesburg, South Africa.,Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samantha Lalla-Edward
- School of Public Health, Wits University, Johannesburg, South Africa.,Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
13
|
Zhang Y, He C, Peasgood T, Hulse ESG, Fairley CK, Brown G, Ofori-Asenso R, Ong JJ. Use of quality-of-life instruments for people living with HIV: a global systematic review and meta-analysis. J Int AIDS Soc 2022; 25:e25902. [PMID: 35396915 PMCID: PMC8994483 DOI: 10.1002/jia2.25902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/07/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Due to the effectiveness of combined antiretroviral therapy and its growing availability worldwide, most people living with HIV (PLHIV) have a near‐normal life expectancy. However, PLHIV continue to face various health and social challenges that severely impact their health‐related quality‐of‐life (HRQoL). The UNAIDS Global AIDS Strategy discusses the need to optimize quality‐of‐life, but no guidance was given regarding which instruments were appropriate measures of HRQoL. This study aimed to review and assess the use of HRQoL instruments for PLHIV. Methods We conducted a global systematic review and meta‐analysis, searching five databases for studies published between January 2010 and February 2021 that assessed HRQoL among PLHIV aged 16 years and over. Multivariable regression analyses were performed to identify factors associated with the choice of HRQoL instruments. We examined the domains covered by each instrument. Random‐effects meta‐analysis was conducted to explore the average completion rates of HRQoL instruments. Results and discussion From 714 publications, we identified 65 different HRQoL instruments. The most commonly used instruments were the World Health Organization Quality‐of‐Life‐ HIV Bref (WHOQOL‐HIV BREF)—19%, Medical Outcome Survey‐HIV (MOS‐HIV)—17%, Short Form‐36 (SF‐36)—12%, European Quality‐of‐Life Instrument‐5 Dimension (EQ‐5D)—10%, World Health Organization Quality‐of‐Life Bref (WHOQOL BREF)—8%, Short Form‐12 (SF‐12)—7% and HIV/AIDS Targeted Quality‐of‐Life (HAT‐QOL)—6%. There were greater odds of using HIV‐specific instruments for middle‐ and low‐income countries (than high‐income countries), studies in the Americas and Europe (than Africa) and target population of PLHIV only (than both PLHIV and people without HIV). Domains unique to the HIV‐specific instruments were worries about death, stigma and HIV disclosure. There were no significant differences in completion rates between different HRQoL instruments. The overall pooled completion rate was 95.9% (95% CI: 94.7−97.0, I2 = 99.2%, p < 0.01); some heterogeneity was explained by country‐income level and study type. Conclusions A wide range of instruments have been used to assess HRQoL in PLHIV, and the choice of instrument might be based on their different characteristics and reason for application. Although completion rates were high, future studies should explore the feasibility of implementing these instruments and the appropriateness of domains covered by each instrument.
Collapse
Affiliation(s)
- Ying Zhang
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christine He
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Tessa Peasgood
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily S G Hulse
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Ofori-Asenso
- Monash Outcomes Research and Health Economics, Monash University, Melbourne, Victoria, Australia.,Real World Data Enabling Platform, Roche Products Ltd, Welwyn Garden City, UK
| | - Jason J Ong
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Wen H, Yang Z, Zhu Z, Han S, Zhang L, Hu Y. Psychometric properties of self-reported measures of health-related quality of life in people living with HIV: a systematic review. Health Qual Life Outcomes 2022; 20:5. [PMID: 35012574 PMCID: PMC8744327 DOI: 10.1186/s12955-021-01910-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/14/2021] [Indexed: 01/31/2023] Open
Abstract
Objective To identify and assess the psychometric properties of patient-reported outcome measures (PROMs) of health-related quality of life (HRQoL) in people living with HIV (PLWH). Methods Nine databases were searched from January 1996 to October 2020. Methodological quality was assessed by using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias Checklist. We used the COSMIN criteria to summarize and rate the psychometric properties of each PROM. A modified Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of evidence. Results Sixty-nine studies reported on the psychometric properties of 30 identified instruments. All studies were considered to have adequate methodological quality in terms of content validity, construct validity, and internal consistency. Limited information was retrieved on cross-cultural validity, criterion validity, reliability, hypothesis testing, and responsiveness. High-quality evidence on psychometric properties was provided for the Medical Outcomes Study HIV Health Survey (MOS-HIV), the brief version of the World Health Organization's Quality of Life Instrument in HIV Infection (WHOQoL-HIV-BREF), 36-Item Short Form Survey (SF-36), Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQoL-HIV), and WHOQoL-HIV. Conclusions The findings from the included studies highlighted that among HIV-specific and generic HRQoL PROMs, MOS-HIV, WHOQoL-HIV-BREF, SF-36, MQoL-HIV, and WHOQoL-HIV are strongly recommended to evaluate HRQoL in PLWH in research and clinics based on the specific aims of assessments and the response burden for participants. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01910-w.
Collapse
Affiliation(s)
- Huan Wen
- Fudan University School of Public Health, Shanghai, China
| | - Zhongfang Yang
- School of Nursing, Fudan University, Shanghai, China.,Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, 305 Fenglin Rd, Shanghai, 200032, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China. .,Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, 305 Fenglin Rd, Shanghai, 200032, China.
| | - Shuyu Han
- Peking University School of Nursing, Beijing, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China. .,Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, 305 Fenglin Rd, Shanghai, 200032, China.
| |
Collapse
|
15
|
Yang Z, Zhu Z, Wen H, Han S, Xing W, Dong T, Guo M, Hu Y. Psychometric properties of self-reported measures of health-related quality of life in people living with HIV: a systematic review protocol. JBI Evid Synth 2021; 19:2829-2838. [PMID: 33993150 DOI: 10.11124/jbies-20-00190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this review is to identify and assess the psychometric properties of patient-reported outcome measures of health-related quality of life in people living with HIV. INTRODUCTION Some reviews have been conducted to identify generic and HIV-specific health-related, quality-of-life measures in people living with HIV. However, these studies did not report the psychometric properties of patient-reported outcome measures, making it difficult for researchers to choose one measure from the existing measures to assess health-related quality of life. This review will highlight various psychometric properties of the validation studies rather than reporting the content of measures. INCLUSION CRITERIA We will consider studies that validate patient-reported outcome measures of health-related quality of life in people living with HIV and evaluate one or more measurement proprieties. Studies published in English or Chinese and conducted in any country or setting will be eligible for inclusion. METHODS PubMed, Embase (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science, ProQuest Dissertations and Theses, Cochrane CENTRAL (Wiley), Wanfang, and CNKI will be searched from January 1, 1996 to the present. The evaluation of measurement properties, data extraction, and data synthesis will be conducted according to JBI methodology. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021253672.
Collapse
Affiliation(s)
- Zhongfang Yang
- School of Nursing, Fudan University, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Huan Wen
- School of Public Health, Fudan University, Shanghai, China
| | - Shuyu Han
- School of Nursing, Fudan University, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Weijie Xing
- School of Nursing, Fudan University, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| | - Tingyue Dong
- Beijing Administration Institute, Beijing, China
| | - Mengdi Guo
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China.,Fudan University Centre for Evidence-based Nursing: A JBI Centre of Excellence, Shanghai, China
| |
Collapse
|
16
|
Xie J, Wang Z, Li Q, He Q, Xu G, Li Y, Zhou K, Li L, Gu J. Associations between antiretroviral therapy-related experiences and mental health status among people living with HIV in China: a prospective observational cohort study. AIDS Res Ther 2021; 18:60. [PMID: 34503529 PMCID: PMC8431891 DOI: 10.1186/s12981-021-00370-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 07/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mental health problems (e.g., depression and anxiety) are among the most commonly reported comorbidities of HIV. Antiretroviral therapy (ART) coverage has increased sharply. The purposes of this prospective cohort study were to investigate the ART-related experiences and whether they were associated with mental health problems among a sample of people living with HIV undergoing ART in China. METHODS The participants were 400 people living with HIV who had started ART for the first time in Guangzhou city. They were followed-up 1-year after ART initiation. Probable depression and moderate/severe anxiety were measured at baseline and Month 12, while experiences related to ART (e.g., side effects and regained self-confidence) were measured at Month 6. Univariate and multivariate logistic regressions were used to explore the associations between baseline characteristics, ART-related experiences and mental health status. RESULTS Among the 300 participants (75.0%) who completed all three surveys, a significant decline in prevalence of probable depression (23.0% at baseline vs. 14.0% at Month 12, P = 0.002) and moderate/severe anxiety (14.7% at baseline vs. 8.7% at Month 12, P = 0.023) was observed during the follow-up period. After adjustment for mental health status and potential confounders at baseline, a number of ART-related experiences at Month 6 were associated with probable depression and/or moderate/severe anxiety measured at Month 12. Improved physical health, relationships with sexual partners, and self-confidence were associated with decreased mental health issues, while the side effects of ART, AIDS-related symptoms, and inconvenience in daily life due to ART use were associated with increased mental health issues. CONCLUSIONS ART-related experiences were associated with mental health problems, tailored mental health promotion interventions targeting these experiences are needed.
Collapse
Affiliation(s)
- Jinzhao Xie
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Shenzhen Research Institute (SZRI), Shenzhen, 518172, Guangdong, China
| | - Quanmin Li
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510080, Guangdong, China
| | - Qiangsheng He
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Guohong Xu
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510080, Guangdong, China
| | - Yonghong Li
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510080, Guangdong, China
| | - Kai Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- Dean's Office, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, 510055, Guangdong, China
| | - Linghua Li
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510080, Guangdong, China.
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
- Sun Yat-Sen Global Health Institute, School of Public Health and Institute of State Governance, Guangzhou, 510080, Guangdong, China.
| |
Collapse
|
17
|
Safer sex in older age: putting combination HIV prevention strategies into practice. THE LANCET. HEALTHY LONGEVITY 2021; 2:e538-e539. [DOI: 10.1016/s2666-7568(21)00174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 11/18/2022] Open
|
18
|
Kuber A, Reuter A, Geldsetzer P, Chimbindi N, Moshabela M, Tanser F, Bärnighausen T, Vollmer S. The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa. Sci Rep 2021; 11:14718. [PMID: 34282184 PMCID: PMC8289961 DOI: 10.1038/s41598-021-94057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
We use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.
Collapse
Affiliation(s)
- Aditi Kuber
- Department of Economics, University of Goettingen, Göttingen, Germany
| | - Anna Reuter
- Department of Economics, University of Goettingen, Göttingen, Germany.
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Mosa Moshabela
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, Durban, South Africa
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Vollmer
- Department of Economics, University of Goettingen, Göttingen, Germany
| |
Collapse
|
19
|
Goh OQ, Kroon E, Sacdalan C, Chan P, Crowell TA, Kanaprach R, Anonworanich J, Vasan S, Wu AW, Phanuphak N, Colby DJ. Persons living with HIV treated in acute HIV infection report good health-related quality of life in Thailand. AIDS Care 2021; 34:949-956. [PMID: 34191663 DOI: 10.1080/09540121.2021.1944596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The health-related quality of life (HRQoL) among persons living with HIV (PLWHA) who initiate ART during acute HIV infection (AHI) is not well studied. Participants in the SEARCH010/RV254 cohort initiated ART during AHI. They completed the Thai version of the World Health Organisation Quality of Life instrument-BREF (WHOQOL-BREF) and Patient Health Questionnaire-9 (PHQ-9) prior to ART initiation and 24 weeks later. Of 452 participants, 406 (90%) completed the WHOQOL-BREF. The median age was 26 years (IQR 22-31), and 98% were men. All WHOQOL-BREF domains demonstrated good internal consistency (Cronbach's alpha >0.70). Confirmatory factor analysis validated the WHOQOL-BREF model. 90% of Pearson correlations between domain scores and general facet items were >0.50. HRQoL in all domains was worse among those with at least moderately severe depression (PHQ-9 ≥ 10) (p<0.0001), supporting discriminant validity. At 24 weeks, there was an improvement of scores in all domains (physical, psychological, social, and environmental) and general facet items (p<0.0001), and the range of mean domain scores was 14.7-15.6 (SD 2.3-2.8). The majority of participants (58-63%) had improved HRQoL in the physical, psychological and environmental domains. It is concluded that HRQoL improves 6 months after initiation of ART in AHI, suggesting a benefit of early ART initiation.
Collapse
Affiliation(s)
- Orlanda Q Goh
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,SingHealth DukeNUS Medicine Academic Clinical Programme, Singapore
| | - Eugène Kroon
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Carlo Sacdalan
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Phillip Chan
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | - Jintanat Anonworanich
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Department of Global Health, University of Amsterdam, Amsterdam, Netherlands
| | - Sandhya Vasan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Donn J Colby
- SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| |
Collapse
|
20
|
Anderson SJ, Murray M, Cella D, Grossberg R, Hagins D, Towner W, Wang M, Clark A, Pierce A, Llamoso C, Ackerman P, Lataillade M. Patient-Reported Outcomes in the Phase III BRIGHTE Trial of the HIV-1 Attachment Inhibitor Prodrug Fostemsavir in Heavily Treatment-Experienced Individuals. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:131-143. [PMID: 34180035 PMCID: PMC8739158 DOI: 10.1007/s40271-021-00534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/05/2022]
Abstract
Introduction Heavily treatment-experienced (HTE) people living with HIV-1 (PLWH) have limited viable antiretroviral regimens available because of multidrug resistance and safety concerns. The first-in-class HIV-1 attachment inhibitor fostemsavir demonstrated efficacy and safety in HTE participants in the ongoing phase III BRIGHTE trial. Objectives We describe patient-reported outcomes (PROs) through week 48. Methods Eligible participants for whom their current regimen was failing were assigned to the randomized cohort (RC; one to two fully active agents remaining) or the nonrandomized cohort (NRC; no fully active agents remaining). PRO assessments included the EQ-5D-3L, EQ-VAS, and Functional Assessment of HIV Infection (FAHI) instruments. Results Both cohorts achieved increases in EQ-5D-3L US- and UK-referenced utility score from baseline at week 24. Mean visual analog scale (VAS) scores in the RC and NRC increased from baseline by 8.7 (95% CI 6.2–11.2) and 5.6 points (95% CI 1.5–9.7) at week 24 and increased from baseline by 9.8 (95% CI 7.0–12.6) and 4.9 points (95% CI 0.6–9.2) at week 48, respectively. Mean increases in FAHI total score from baseline to weeks 24 and 48 in the RC were 6.9 (95% CI 4.2–9.7) and 5.8 (95% CI 2.7–9.0), respectively, whereas mean increases in physical and emotional well-being subscale scores were 2.7 (95% CI 1.9–3.6) and 2.4 (95% CI 1.3–3.4) and 3.2 (95% CI 2.2–4.2) and 2.6 (95% CI 1.6–3.7), respectively, with little to no change in other subscales. Conclusions Improvements in major domains of the EQ-VAS and FAHI through week 48, combined with efficacy and safety results, support the use of fostemsavir for HTE PLWH. Trial Registration Number and Date NCT02362503; February 13, 2015.
Collapse
Affiliation(s)
- Sarah-Jane Anderson
- GlaxoSmithKline, Brentford, UK. .,ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
| | - Miranda Murray
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Debbie Hagins
- Georgia Department of Public Health, Coastal Health District, Chatham CARE Center, Savannah, GA, USA
| | - William Towner
- Southern California Kaiser Permanente Medical Group, Los Angeles, CA, USA
| | | | - Andrew Clark
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Amy Pierce
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | | |
Collapse
|
21
|
Adedimeji AA, Hoover DR, Shi Q, Kim H, Brazier E, Ross J, Murenzi G, Twizere C, Lelo P, Nsonde D, Ajeh R, Dzudie A, Nash D, Yotebieng M, Anastos K. Trends in demographic and clinical characteristics and initiation of antiretroviral therapy among adult patients enrolling in HIV care in the Central Africa International epidemiology Database to Evaluate AIDS (CA-IeDEA) 2004 to 2018. J Int AIDS Soc 2021; 24:e25672. [PMID: 34152663 PMCID: PMC8216247 DOI: 10.1002/jia2.25672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/17/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The Central Africa International epidemiology Database to Evaluate AIDS (CA-IeDEA) is an open observational cohort study investigating impact, progression and long-term outcomes of HIV/AIDS among people living with HIV (PLWH) in Burundi, Cameroon, Democratic Republic of Congo (DRC), Republic of Congo (ROC) and Rwanda. We describe trends in demographic, clinical and immunological characteristics as well as antiretroviral therapy (ART) use of patients aged > 15 years entering into HIV care in the participating CA-IeDEA site. METHODS Information on sociodemographic characteristics, height, weight, body mass index (BMI), CD4 cell count, WHO staging and ART status at entry into care from 2004 through 2018 were extracted from clinic records of patients aged > 15 years enrolling in HIV care at participating clinics in Burundi, Cameroon, DRC, ROC and Rwanda. We assessed trends in patient characteristics at enrolment in HIV care including ART initiation within the first 30 days after enrolment in care and calculated proportions, means and medians (interquartile ranges) for the main variables of interest. RESULTS Among 69,176 patients in the CA-IeDEA cohort, 39% were from Rwanda, 24% from ROC, 18% from Cameroon, 14% from Burundi and 5% from DRC. More women (66%) than men enrolled in care and subsequently initiated ART. Women were also younger than men (32 vs. 38 years, P < 0.001) at enrolment and at ART initiation. Trends over time show increases in median CD4 cell count at enrolment from 190 cells/µL in 2004 to 334 cells/µL in 2018 at enrolment. Among those with complete data on CD4 counts (60%), women had a higher median CD4 cell count at care entry than men (229 vs. 249 cells/µL, P < 0.001). Trends in the proportion of patients using ART within 30 days of enrolment at the participating site show an increase from 16% in 2004 to 75% in 2018. CONCLUSIONS Trends from 2004 to 2018 in the characteristics of patients participating in the CA-IeDEA cohort highlight improvements at entry into care and subsequent ART initiation including after the implementation of Treat All guidelines in the participating sites.
Collapse
Affiliation(s)
- Adebola A Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of Medicine/Montefiore Medical CenterBronxNYUSA
| | | | - Qiuhu Shi
- Department of Public HealthSchool of Health Sciences and PracticeNew York Medical CollegeValhallaNYUSA
| | - Hae‐Young Kim
- Department of Public HealthSchool of Health Sciences and PracticeNew York Medical CollegeValhallaNYUSA
| | - Ellen Brazier
- School of Public HealthCity University of New YorkNew YorkNYUSA
| | - Jonathan Ross
- Department of MedicineAlbert Einstein College of MedicineBronxNYUSA
| | - Gad Murenzi
- Division of Clinical EducationRwanda Military HospitalKanombe, KigaliRwanda
| | | | - Patricia Lelo
- Pediatric Hospital Kalembe LembeKinshasaDemocratic Republic of Congo
| | | | - Rogers Ajeh
- Clinical Research EducationNetworking and ConsultancyYaoundeCameroon
| | - Anastase Dzudie
- Clinical Research EducationNetworking and ConsultancyYaoundeCameroon
| | - Denis Nash
- School of Public HealthCity University of New YorkNew YorkNYUSA
| | - Marcel Yotebieng
- Department of MedicineAlbert Einstein College of MedicineBronxNYUSA
| | - Kathryn Anastos
- Department of Epidemiology and Population HealthAlbert Einstein College of Medicine/Montefiore Medical CenterBronxNYUSA
- Department of MedicineAlbert Einstein College of MedicineBronxNYUSA
| |
Collapse
|
22
|
Marconi CSC, Lins-Kusterer L, Brites C, Gomes-Neto M. Comparison of functioning and health-related quality of life among patients with HTLV-1, HIV, and HIV-HTLV-1-coinfection. Rev Soc Bras Med Trop 2021; 54:e0759-2020. [PMID: 33759928 PMCID: PMC8008869 DOI: 10.1590/0037-8682-0759-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION: Human immunodeficiency virus (HIV) and human T-cell leukemia virus-1 (HTLV-1) viruses are associated with a high global burden of disease, and coinfection is a frequently reported event. We aimed to compare the functioning and health-related quality of life (HRQoL) of patients infected with HTLV-1, HIV, and HIV-HTLV-1. METHODS: We conducted a cross-sectional study of patients older than 18 years who had an HTLV-1 infection (Group A), HIV infection (Group B), or HIV-HTLV-1 coinfection (Group C). The functioning profiles were evaluated using handgrip strength, Berg balance scale (BBS), timed “up and go” (TUG) test, and 5-m walk test (m/s). We used the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire to measure disability. The HRQoL was evaluated using a 36-item short-form health survey. For data with parametric and non-parametric distribution, we used analysis of variance with Bonferroni correction and the Kruskal-Wallis test, followed by Dunn’s pairwise tests with Bonferroni correction. RESULTS: We enrolled 68 patients in Group A, 39 in Group B, and 29 in Group C. The scores for handgrip strength, BBS, TUG test, all the WHODAS domains, and HRQoL were poorer for Groups A and C than for Group B. CONCLUSIONS: Compared to patients with HIV infection, those with HIV-HTLV-1 coinfection and HTLV-1 infection had poor functioning and HRQoL scores. HTLV-1 infection was associated with reduced functioning and HRQoL in patients with a single HTLV-1 infection and HIV-HTLV-1 coinfection.
Collapse
Affiliation(s)
- Cleyde Sheyla Chachaqui Marconi
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil.,Universidade Federal da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brasil
| | - Liliane Lins-Kusterer
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil.,Universidade Federal da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brasil.,Complexo Hospitalar Universitário Professor Edgard Santos, Laboratório de Pesquisa em Doenças Infecciosas, Salvador, BA, Brasil
| | - Carlos Brites
- Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil.,Universidade Federal da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brasil.,Complexo Hospitalar Universitário Professor Edgard Santos, Laboratório de Pesquisa em Doenças Infecciosas, Salvador, BA, Brasil
| | - Mansueto Gomes-Neto
- Universidade Federal da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brasil.,Complexo Hospitalar Universitário Professor Edgard Santos, Laboratório de Pesquisa em Doenças Infecciosas, Salvador, BA, Brasil.,Universidade Federal da Bahia, Departamento de Fisioterapia, Salvador, BA, Brasil
| |
Collapse
|
23
|
Mohammed SA, Yitafr MG, Workneh BD, Hailu AD. Health-related quality of life and associated factors among people living with human immunodeficiency virus on highly active antiretroviral therapy in North East Ethiopia: Cross-sectional study. PLoS One 2021; 16:e0247777. [PMID: 33667245 PMCID: PMC7935299 DOI: 10.1371/journal.pone.0247777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/14/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION HIV/AIDS remains a public health concern affecting millions of people across the world. Although the health-related quality of life (HRQoL) of patients living with HIV has significantly improved after treatment, its chronicity makes the HRQoL uncertain. This study assessed factors associated with the health-related quality of life among people living with HIV/AIDS on HAART in North-East Ethiopia. METHODS An institutional-based cross-sectional study was conducted from March to April 2018, and systematic random sampling was used to select 235 participants who were on HAART. HRQoL was assessed using the Medical Outcomes Study HIV Health Survey. Descriptive and multiple linear regression analysis were computed using the statistical package for social sciences version 20. RESULTS The study revealed one-factor structure and had good overall internal consistency (78.5). Over one-third (42.6%; 95% CI; 36.2%, 48.9%) of participants had good HRQoL. The least HRQoL mean score was found for cognitive functioning 32.21(±19.78), followed by social functioning 40.58(±29.8). Factors associated with the overall HRQoL were 25-45 years of age (β = - 3.55, 95% CI;-6.54, -0.55), working in private sector (β = -5.66, 95% CI;-9.43, -1.88), government (β = -4.29, 95% CI;-7.83, -0.75) and self-employment (β = -8.86, 95% CI;-13.50, -4.21), 100-200 (β = - 4.84, 95% CI;-9.04, -0.63) and 201-350 CD4 at the time of diagnosis (β = - 7.45, 95% CI;-11.73, -3.16), 351-500 current CD4 level (β = 8.34, 95% CI;5.55, 11.41), 6-10 years of disease duration (β = -8.28, 95% CI;-12.51, -4.04), WHO stage II (β = -4.78, 95% CI;-8.52, -1.04) and III (β = 3.42, 95% CI;0.06, 6.79) during treatment initiation and not taking of Cotrimoxazole prophylaxis (β = -5.79, 95% CI;-8.34, -3.25). CONCLUSIONS High proportion of participants had a poor HRQoL. Routine assessment and appropriate interventions at each visit is recommended to improve HRQoL.
Collapse
Affiliation(s)
- Solomon Ahmed Mohammed
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Minilu Girma Yitafr
- Department of Pharmacy, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | | |
Collapse
|
24
|
Laher AE, Venter WDF, Richards GA, Paruk F. Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa. South Afr J HIV Med 2021; 22:1177. [PMID: 33604064 PMCID: PMC7876985 DOI: 10.4102/sajhivmed.v22i1.1177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background Despite improved availability and better access to antiretroviral therapy (ART), approximately 36% of human immunodeficiency virus (HIV)-positive South Africans are still not virally suppressed. Objective The aim of this study was to describe the patterns of presentation of HIV-positive patients to a major central hospital emergency department (ED). Methods In this prospectively designed study, consecutive HIV-positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) adult ED were enrolled between 07 July 2017 and 18 October 2018. Results A total of 1224 participants were enrolled. Human immunodeficiency virus was newly diagnosed in 212 (17.3%) patients, 761 (75.2%) were on ART, 245 (32.2%) reported ART non-adherence, 276 (22.5%) had bacterial pneumonia, 244 (19.9%) had tuberculosis (TB), 86 (7.0%) had gastroenteritis, 205 (16.7%) required intensive care unit admission, 381 (31.1%) were admitted for ≥ 7 days and 166 (13.6%) died. With regard to laboratory parameters, CD4 cell count was < 100 cell/mm3 in 527 (47.6%) patients, the viral load (VL) was > 1000 copies/mL in 619 (59.0%), haemoglobin was < 11 g/dL in 636 (56.3%), creatinine was > 120 µmol/L in 294 (29.3%), lactate was > 2 mmol/L in 470 (42.0%) and albumin was < 35 g/L in 633 (60.8%). Conclusion Human immunodeficiency virus-positive patients presenting to the CMJAH ED demonstrated a high prevalence of opportunistic infections, required a prolonged hospital stay and had high mortality rates. There is a need to improve the quality of ART services and accessibility to care.
Collapse
Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fathima Paruk
- Department of Critical Care, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
25
|
Abstract
Introduction Over the past decade, the global response to HIV has led to a reduction in the number of new infections, and a decrease in associated mortality. Yet, the number of people living with HIV (PLHIV) is high, with an estimated 38 million infected worldwide. As HIV shifts from being an acute terminal illness to a chronic condition, evaluating programmatic responses to HIV with sole reliance on biological markers (such as viral load or CD4 cell count) as proxies for patient health may no longer be suitable. HIV affects the lives of those infected in myriad ways which should be reflected in programme evaluations by measuring health-related quality of life, in addition to biomarkers. Discussion In this commentary we argue that there is a pressing need to review how a "good" health outcome is defined and measured in light of care systems moving towards value-based frameworks that measure value in terms of the actual health outcomes achieved (rather than processes of care), global response shifting to providing long-term care for PLHIV in the community, and integrating HIV as part of universal health coverage plans. Efforts should be directed towards validating generic and disease specific patient-reported measures of PLHIV, to identify the most suitable tools. Such efforts will ensure that patient experience is appropriately captured, especially to be used in programme or economic evaluations. Conclusions It is only by recognising and measuring the full range of health, mental and social outcomes related to the disease that the health status of PLHIV can be fully understood.
Collapse
|
26
|
Social Capital in Old People Living with HIV Is Associated with Quality of Life: A Cross-Sectional Study in China. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7294574. [PMID: 33313316 PMCID: PMC7721488 DOI: 10.1155/2020/7294574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/22/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
Objective Old people living with HIV (PLWH) are experiencing a lower quality of life (QoL) than their younger counterparts and have received insufficient attention in China. Given that social capital has been proven to be effective in improving QoL in other countries, we aimed to examine the association between social capital and QoL among old PLWH in China. Methods The data presented in this study was based on the baseline sample of an ongoing observational prospective cohort study, which was carried out from November 2018 to February 2019. Participants were old PLWH aged ≥50 in Sichuan, China, and were recruited by stratified multistage cluster sampling from 30 communities/towns. A total of 529 eligible participants finished the face-to-face investigation to measure their social capital (i.e., individual and family- (IF-) based social capital and community and society- (CS-) based social capital) and QoL. The QoL's dimensions of physical health summary (PCS) and mental health summary (MCS) were taken as dependent variables. Stepwise linear regression models were used to examine the association between social capital and QoL. Results After considering all significant covariates, the PCS was nonsignificantly correlated with IF-based social capital (β = −0.08, 95% CI [-0.28-0.11]) and CS-based social capital (β = 0.28, 95% CI [-0.03-0.59]), and MCS was significantly correlated with IF-based social capital (β = 0.77, 95% CI [0.54-0.99], p < 0.001) and CS-based social capital (β = 0.40, 95% CI [0.08-0.72], p < 0.05). Conclusion Targeted interventions related to building up social capital should be applied to improve the QoL of old PLWH. Providing extra relief funds and allowances might be helpful to improve PCS; improving community networking and engagement and improving family care might be helpful to improve MCS among this vulnerable population.
Collapse
|
27
|
What shapes resilience among people living with HIV? A multi-country analysis of data from the PLHIV Stigma Index 2.0. AIDS 2020; 34 Suppl 1:S19-S31. [PMID: 32881791 DOI: 10.1097/qad.0000000000002587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To inform efforts to promote greater resilience among people living with HIV (PLHIV), we examined associations between resilience and factors at the individual, interpersonal and structural/policy levels in three countries. DESIGN Data come from the PLHIV Stigma Index 2.0, a cross-sectional survey with PLHIV, implemented from 2017 to 2019 in Cambodia (n = 1207), the Dominican Republic (n = 891), and Uganda (n = 391). METHODS Hierarchical multiple regression was used to assess associations between resilience and factors at the individual/interpersonal/structural-policy levels, controlling for potential confounders. Resilience was measured by the previously tested PLHIV Resilience Scale. RESULTS About 60% of respondents were women; mean time since HIV diagnosis was 11 years in Cambodia and seven in the Dominican Republic /Uganda. Resilience varied substantially across the six province/districts per country (all p < 0.001). In multivariable analyses, higher resilience was associated with lower internalized stigma (all three countries), no experience of human rights abuses (Dominican Republic), no food/housing insecurity (Uganda), and greater community awareness of legal protections for PLHIV (Cambodia and Dominican Republic). HIV-related enacted stigma (i.e., discrimination) in the community was associated with lower resilience in Cambodia, but higher resilience in the Dominican Republic. The set of structural/policy-level factors in Cambodia and the Dominican Republic, and individual-level in Uganda, explained the most variance in resilience. CONCLUSION Factors at multiple levels affect whether PLHIV in Cambodia, the Dominican Republic, and Uganda report resilience. Multilevel interventions are required to promote resilience among PLHIV, and should incorporate efforts to reduce internalized stigma and promote supportive structural/legal environments including broader awareness of legal protections for PLHIV.
Collapse
|
28
|
Maleki MR, Derakhshani N, Azami-Aghdash S, Naderi M, Nikoomanesh M. Quality of Life of People with HIV/AIDS in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1399-1410. [PMID: 33083316 PMCID: PMC7554383 DOI: 10.18502/ijph.v49i8.3861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Assessing the quality of life in HIV/AIDS patients is of great importance not only for evaluating the effect of the disease, but also to measure the impact of the interventions in order to improve their quality of life in clinical researches. Therefore, this study aimed to systematically review the quality of life of HIV/AIDS patients in Iran. Methods: In this systematic review and meta-analysis, the literature search using the related chain of keywords was conducted from 1 Jan 1987 to 30 Apr 2019 in PubMed, Scopus, Web of Science, Embase, Iranian Scientific Information Database (SID), and Magiran. Moreover, hand search of the key journals and the gray literature was performed. The meta-analysis was performed by CMA2 software. Results: Out of the 1576 retrieved records, eight studies met the inclusion criteria. The average age of the patients was 37.15 ± 9.46 years. The average score of quality of life before and after sensitivity analysis was (39.13 [28.36–49.901 95% CI P>0.000] vs. 49.05 [46.31–51.79 95% CI P>0.000]). Moreover, the average score of quality of life was respectively 38.86±3.83 vs. 40±6.37 among married compared with single patients, 56.33±4.67 vs. 43.64±1.94 for employment vs. unemployment status. While quality of life was measured in terms of education level, the score was 29.59±9.34 vs. 41.65±4.45 in the individuals with primary school versus academic education. Conclusion: The QOL score of the HIV/AIDS patients in Iran was significantly low. Therefore, the study highlights the importance of strengthening efforts to undertake necessary investigations in order to provide adequate health insurance, extensive and affordable welfare services, and more appropriate social and mental supports in order to improve the quality of life of the individuals with HIV/AIDS in Iran.
Collapse
Affiliation(s)
- Mohammad Reza Maleki
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Derakhshani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehran Naderi
- Department of Food Science and Technology, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Nikoomanesh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
29
|
Pujasari H, Levy J, Culbert G, Steffen A, Carley D, Kapella M. Sleep disturbance, associated symptoms, and quality of life in adults living with HIV in Jakarta, Indonesia. AIDS Care 2020; 33:39-46. [PMID: 32266830 DOI: 10.1080/09540121.2020.1748868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Adverse symptom experiences, including sleep disturbances, are important negative predictors of quality of life (QoL), but few studies conducted in low-income countries have examined the impact of poor sleep and its associated symptoms on QoL among people living with HIV (PLWH). To this end, 200 PLWH who were receiving treatment with antiretroviral therapy (ART) were recruited through a community nongovernment organization in Jakarta, Indonesia. Validated instruments measured QoL, sleep disturbance, fatigue, pain, ART adherence, substance use, drug use severity, and methadone treatment. Descriptive statistics, bivariate correlations, and multivariate linear regression were conducted to identify independent correlates of QoL. Overall, participants perceived their QoL as being good to very good (mean = 105.70, standard deviation = 14.7) and higher among women than men (p < 0.05). After adjusting for sex, education, drug-use severity, and ART adherence, QoL was negatively associated with fatigue, insomnia, and pharmacological treatment with methadone. Along with other known symptoms of HIV, sleep problems and their complications are important to clinically address and research more fully to assure satisfying QoL among PLWH.
Collapse
Affiliation(s)
- Hening Pujasari
- Faculty of Nursing, Universitas Indonesia, Depok, Jawa Barat, Indonesia
| | - Judith Levy
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Gabriel Culbert
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alana Steffen
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - David Carley
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Mary Kapella
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
30
|
Global Research on Quality of Life of Patients with HIV/AIDS: Is It Socio-Culturally Addressed? (GAP RESEARCH). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062127. [PMID: 32210042 PMCID: PMC7143369 DOI: 10.3390/ijerph17062127] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/18/2023]
Abstract
Quality of life (QOL) has been considered as an important outcome indicator in holistic care for HIV-infected people, especially as HIV/AIDS transforms from a fatal illness to a chronic condition. This study aimed to identify trends and emerging topics among research concerning the QOL of people living with HIV/AIDS (PLWHA). The analyzed data were English papers published from 1996 to 2017, searched and extracted from the Web of Science Core Collection. Collaborations between countries and the correlation between the keywords were visualized by VOSviewer while the abstracts’ content was analyzed using exploratory factor analysis and Jaccard’s’ similarity index. There has been an increase in both the number of publications and citations. The United Nations of America leads in terms of paper volume. The cross-nation collaborations are mainly regional. Despite a rather comprehensive coverage of topics relating to QOL in PLWHA, there has evidently been a lack of studies focusing on socio-cultural factors and their impacts on the QOL of those who are HIV-infected. Further studies should consider investigating the role of socio-cultural factors, especially where long-term treatment is involved. Policy-level decisions are recommended to be made based on the consideration of cultural factors, while collaborations between developed and developing nations, in particular in HIV/AIDS-ridden countries, are strongly recommended.
Collapse
|
31
|
Melaku T, Mamo G, Chelkeba L, Chanie T. Health-Related Quality of Life Among People Living with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy in Ethiopia: PROQOL-HIV Based Survey. PATIENT-RELATED OUTCOME MEASURES 2020; 11:73-86. [PMID: 32184689 PMCID: PMC7063799 DOI: 10.2147/prom.s239429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/23/2020] [Indexed: 11/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Girma Mamo
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Legese Chelkeba
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tesfahun Chanie
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
32
|
Emuren L, Welles S, Macalino G, Evans AA, Polansky M, Ganesan A, Colombo RE, Agan BK. Predictors of health-related quality of life among military HIV-infected individuals. Qual Life Res 2020; 29:1855-1869. [PMID: 32076926 DOI: 10.1007/s11136-020-02441-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine long-term predictors of health-related quality of life (HRQOL) and evaluate the treatment effect of highly active antiretroviral therapy (HAART) on HRQOL in the US Military HIV Natural History Study (NHS) cohort. METHODS Participants were a nested cohort of the NHS who responded to the Rand Short Form 36 questionnaire administered from 2006 to 2010. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed using standard algorithms. HAART-status was categorized as non-protease inhibitor-based (NPI-HAART), protease inhibitor-based (PI-HAART), HAART-naïve, or off-HAART. Mixed linear random effects models were used to estimate changes in PCS and MCS over time for treatment and covariates (including CD4 count, HIV viral load, medical and mental comorbidities). RESULTS Eight hundred and twelve participants met the inclusion criteria. There was no difference in PCS or MCS between those on PI-HAART compared to NPI-HAART. Significant predictors of PCS were CD4 count < 200 cells/mm3 (β = - 2.90), CD4 count 200-499 cells/mm3 (β = - 0.80), and mental comorbidity (β = - 3.23). Others were medical comorbidity, AIDS-defining illness, being on NPI-HAART, HAART-naïve, age, and rank. Those with medical comorbidities experienced yearly improvement in PCS. Predictors of MCS were CD4 count < 200 cells/mm3 (β = - 2.53), mental comorbidity (β = - 4.58), and being African American (β = 2.59). CONCLUSION HRQOL was significantly affected by low CD4 count, medical and mental comorbidities. Addressing these modifiable factors would be expected to improve the physical and mental HRQOL of the cohort. Our study did not find any treatment benefit of NPI-HAART over PI-HAART on HRQOL in the long term.
Collapse
Affiliation(s)
- Leonard Emuren
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA.,Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, USA
| | - Seth Welles
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Grace Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Alison A Evans
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Marcia Polansky
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.,Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.,Division of Infectious Diseases, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
| | | |
Collapse
|
33
|
Garrido-Hernansaiz H, Alonso-Tapia J. Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study. Scand J Psychol 2020; 61:616-624. [PMID: 31999836 DOI: 10.1111/sjop.12621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/11/2019] [Indexed: 01/01/2023]
Abstract
This longitudinal study examined whether past resilience and internalized stigma predicted anxiety and depression among newly diagnosed Spanish-speaking people living with HIV (PLWH). We also analyzed whether coping strategies mediated this relationship. Data were collected at two time points from 119 PLWH. Approximately a third of participants had scores indicative of anxiety symptoms, the same result was found for depressive symptoms. Structural equations modeling revealed that 61% of the variance of anxiety and 48% of the variance of depression 8 months after diagnosis was explained by the proposed model, which yielded a good fit to data. Anxiety and depressive symptoms were significantly and negatively predicted by positive thinking, thinking avoidance, and past resilience, and positively predicted by self-blame. Additionally, anxiety was positively predicted by internalized stigma. Past resilience negatively predicted internalized stigma, self-blame, and thinking avoidance and it positively predicted positive thinking. Internalized stigma positively predicted self-blame. Moreover, internalized stigma had a significant indirect effect on anxiety symptoms through self-blame, and past resilience had significant indirect effects on anxiety symptoms and depressive symptoms through internalized stigma and coping. The results point to the need for clinicians and policy makers to conduct systematic assessments and implement interventions to reduce internalized stigma and train people living with HIV to identify and use certain coping behaviors.
Collapse
Affiliation(s)
- Helena Garrido-Hernansaiz
- Department of Education and Psychology, Centro Universitario Cardenal Cisneros, Universidad de Alcalá, Madrid, Spain
| | - Jesús Alonso-Tapia
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
34
|
Hailu T, Yitayal M, Yazachew L. 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. Patient Prefer Adherence 2020; 14:1873-1887. [PMID: 33116432 PMCID: PMC7567992 DOI: 10.2147/ppa.s269577] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Tilahun Hailu
- Department of Health System, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Lake Yazachew University of Gondar, P. O. Box: 196, Gondar, Ethiopia Email
| |
Collapse
|
35
|
Abstract
PURPOSE HIV infection and concomitant HPV-associated anal lesions may significantly impact on patients' quality of life (QoL), as they are predicted to have negative effects on health, psyche, and sexuality. MATERIAL AND METHODS Fifty-two HIV+ patients with HPV-associated anal lesions were enrolled in a survey approach after undergoing routine proctologic assessment and therapy for HPV-associated anal lesions if indicated over a time span of 11 years (11/2004-11/2015). Therapy consisted of surgical ablation and topic treatment. QoL was analyzed using the SF-36 and the CECA questionnaires. RESULTS Fifty-two of 67 patients (77.6%) were successfully contacted and 29/52 provided full information. The mean age was 43.8 ± 12.8 years. The median follow-up from treatment to answering of the questionnaire was 34 months. Twenty-one percent (6/29) of the patients reported suffering from recurrence of condyloma acuminata, three patients from anal dysplasia (10.3%). In the SF-36, HIV+ patients did not rate their QoL as significantly different over all items after successful treatment of HPV-associated anal lesions. In the CECA questionnaire, patients with persisting HPV-associated anal lesions reported significantly higher emotional stress levels and disturbance of everyday life compared to patients who had successful treatment (71.9/100 ± 18.7 vs. 40.00/100 ± 27.4, p = 0.004). Importantly, the sexuality of patients with anal lesions was significantly impaired (59.8/100 ± 30.8 vs. 27.5/100 ± 12.2, p = 0.032). CONCLUSION HPV-associated anal lesions impact significantly negative on QoL in HIV+ patients. Successful treatment of HPV-associated anal lesions in HIV+ patients improved QoL. Specific questionnaires, such as CECA, seem to be more adequate than the SF-36 in this setting.
Collapse
|
36
|
Zhakipbayeva BT, Nugmanova ZS, Tracy M, Birkhead GS, Akhmetova GM, DeHovitz J. Factors influencing the quality of life in persons living with human immunodeficiency virus infection in Almaty, Kazakhstan. Int J STD AIDS 2019; 30:1318-1328. [PMID: 31726932 PMCID: PMC7433689 DOI: 10.1177/0956462419876484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study purpose was to determine the factors associated with health-related quality of life (HRQoL) among people living with HIV (PLHIV) in Kazakhstan. A convenience sample of 531 adult PLHIV registered at the Almaty City AIDS Center was used for this cross-sectional study. HRQoL data were collected with the World Health Organization’s Quality of Life HIV brief questionnaire, depression – with Patient Health Questionnaire-9, and clinical data were retrieved from medical records. Multivariate logistic and Tobit censored regressions were used to examine the relationship of socio-demographic, behavioral, and clinical factors with HRQoL and the six specific HRQoL domains: 35.8% of participants did not report good HRQoL. The following variables were identified as independent predictors of poor HRQoL: probable depression (adjusted odds ratio [AOR] 13.42, 95% confidence interval [CI]: 4.56–39.52); history of injecting drug use (AOR 2.10, 95% CI: 1.40–3.14); CD4+ T-cell count <200 cells/mm3 (AOR 2.17, 95% CI: 1.30–3.62); previously married status (AOR 2.23, 95% CI: 1.16–4.28); and co-infection with tuberculosis, syphilis, toxoplasmosis, Chlamydia, herpes simplex, or cytomegalovirus (AOR 1.59, 95% CI: 1.06–2.39). HRQoL of PLHIV in Almaty was independently influenced by several factors. An interdisciplinary approach is needed in planning healthcare and social services addressing improvement of HRQoL among PLHIV.
Collapse
Affiliation(s)
- Bakhytkul T Zhakipbayeva
- Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- Bakhytkul T Zhakipbayeva, 94 Tole bi Street, Almaty 050012, Kazakhstan.
| | - Zhamilya S Nugmanova
- Division of HIV-Infection and Infection Control, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany, SUNY, Albany, NY, USA
| | - Guthrie S Birkhead
- Department of Epidemiology and Biostatistics, University at Albany, SUNY, Albany, NY, USA
| | - Gulzhakhan M Akhmetova
- Division of HIV-Infection and Infection Control, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Jack DeHovitz
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
37
|
Aliyu A, El-Kamary S, Brown J, Agins B, Ndembi N, Aliyu G, Jumare J, Adelekan B, Dakum P, Abimiku A, Charurat M. Performance and trend for quality of service in a large HIV/AIDS treatment program in Nigeria. AIDS Res Ther 2019; 16:29. [PMID: 31575377 PMCID: PMC6774212 DOI: 10.1186/s12981-019-0242-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background As antiretroviral therapy (ART) programs expand access, there is an increase in burden to a healthcare system. These results are reduced provider-patient contact time and poor programmatic and patient outcomes. Quality management offers providers a standardized approach for addressing the appropriateness of care to be applied in resource-limited settings. This study aimed to determine the trend of performance on HIV/AIDS quality management indicators of health facilities providing ART over a period of 5 years. Methods The annual performance scores of quality of care (QoC) indicators of 31 health facilities providing ART was extracted from a database covering a period of 5 years (from October 2008 to September 2012). The data are percentages that indicate scores of each health facility assessed based on compliance to National ART guidelines categorized into several indicator domains. A Chi square statistic for the trend, as well as test for departure from the trend line was determined. The p value associated with each indicator provides the significant level for testing an alternative hypothesis that the rate of change over the period considered for that indicator does not equal to zero. The slope of the regression line also gives the magnitude of the rate of change for each indicator by healthcare level across the review period. Results Generally, performance trends showed improvement across most indicator domains. The highest improvement occurred for “3 month loss to follow-up” and “1 year no-visit”, with scores declining from 37 to 3%, and 42% to 12% respectively. However, there was a sharp decline in performance between 2010 and 2012 in weight monitoring of patients (p < 0.01), adherence assessment to ARVs (p < 0.01) and hematocrit measurements (p = 0.01). The aggregate rate of change β, as obtained from the slope of the trend line is highly significant (p < 0.01) for all the quality of care indicators considered, whether improving or declining. Conclusion Periodic assessment to determine HIV/AIDS quality of care can guide rapid scale-up of services to achieve universal coverage in resource-limited settings. Determining trends to understand patterns is very useful for improving programmatic and patient outcomes.
Collapse
|
38
|
Cuéllar-Flores I, Saínz T, Velo C, González-Tomé MI, García-Navarro C, Fernández-Mcphee C, Guillén S, Ramos JT, Miralles P, Rubio R, Bernardino JI, Prieto L, Rojo P, de Ory SJ, Navarro ML. Impact of HIV on the health-related quality of life in youth with perinatally acquired HIV. World J Pediatr 2019; 15:492-498. [PMID: 31286425 DOI: 10.1007/s12519-019-00281-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies investigating health-related quality of life (HRQoL) in youth with perinatally acquired HIV (PHIV+) are scarce. This study aimed to compare HRQoL of PHIV+ to sociodemographic-matched youth not living with HIV (HIV-), Spanish general youth population, and to explore associations between sociodemographic variables, drug consumption, and HRQoL. METHODS PHIV+ youth were randomly selected from CoRISpe database (Cohort of the Spanish Pediatric HIV Network). HRQoL was evaluated by SF-12v2. RESULTS Thirty-nine PHIV+ youth (mean age: 23.36 years, SD = 3.83) and thirty-nine HIV- youth (mean age: 22.97 years, SD = 3.80) participated in this study. PHIV+ obtained lower scores in SF-12 physical health subscale (PCS) than HIV- (P = 0.001) and Spanish general youth population (P = 0.006). PHIV+ had lower scores on the mental health subscale (MCS) than the Spanish general youth population (P < 0.001). PHIV+ who were at school obtained better scores than those were not at school. PHIV+ youth who had used cocaine and cannabis had lower scores in MCS (P = 0.002). CONCLUSIONS There is a need for HRQoL management in the associated medical follow-up.
Collapse
Affiliation(s)
| | - Talía Saínz
- Infectious Diseases Service, Paed Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Carlos Velo
- Infectious Diseases Service, Paed Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | - Sara Guillén
- Paed Department, Hospital de Getafe, Madrid, Spain
| | - José Tomás Ramos
- Pediatric Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Miralles
- Infectious Diseases Service, H. Gregorio Marañón, Madrid, Spain
| | - Rafael Rubio
- HIV Service, Hospital 12 de Octubre, Madrid, Spain
| | | | - Luis Prieto
- Infectious Diseases Service, Paed Department, Hospital 12 de Octubre, Madrid, Spain
| | - Pablo Rojo
- Infectious Diseases Service, Paed Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Maria Luisa Navarro
- Infectious Diseases Service, Paed Department, H. Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IiSGM), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| |
Collapse
|
39
|
Chapman Lambert C, Westfall A, Modi R, Amico RK, Golin C, Keruly J, Quinlivan EB, Crane HM, Zinski A, Turan B, Turan JM, Mugavero MJ. HIV-related stigma, depression, and social support are associated with health-related quality of life among patients newly entering HIV care. AIDS Care 2019; 32:681-688. [PMID: 31167537 DOI: 10.1080/09540121.2019.1622635] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Entering HIV care is a vulnerable time for newly diagnosed individuals often exacerbating psychosocial difficulties, which may contribute to poor health-related quality of life (HRQOL) ultimately influencing health behaviors including ART adherence, the driver of viral load suppression. Understanding HRQOL in people newly entering HIV care is critical and has the potential to guide practice and research. This exploratory cross-sectional study examined demographic, clinical, and psychosocial factors associated with limitations in four specific domains of HRQOL among persons initially entering outpatient HIV care at four sites in the United States (n = 335). In the unadjusted analysis, female gender was significantly associated with sub-optimal HRQOL with women having increased odds of reporting HRQOL challenges with pain, mood, mobility, and usual activity when compared to men. The adjusted models demonstrated attenuation of parameter estimates and loss of statistical significance for the associations with impaired HRQOL observed among women in unadjusted analyses, suggesting psychosocial factors related to HRQOL are complex and interrelated. Findings are consistent with a robust literature documenting gender-related health disparities. Programs aimed at improving HRQOL for persons initially entering HIV care are warranted generally, and specifically for women, and must address modifiable psychosocial factors via mechanisms including coping and social support.
Collapse
Affiliation(s)
| | - Andrew Westfall
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Riddhi Modi
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rivet K Amico
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Carol Golin
- School of Public Health, Department of Heath Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeanne Keruly
- School of Medicine, Division of Infectious Disease, John Hopkins University, Baltimore, MD, USA
| | - Evelyn Byrd Quinlivan
- School of Public Health, Department of Heath Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heidi M Crane
- School of Medicine, Division of Infectious Disease, John Hopkins University, Baltimore, MD, USA
| | - Anne Zinski
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- College of Arts and Sciences, Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- School of Public Health, Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
40
|
Costa JDO, Pearson SA, Acurcio FDA, Bonolo PDF, Silveira MR, Ceccato MDGB. Health-related quality of life among HIV-infected patients initiating treatment in Brazil in the single-tablet regimen era. AIDS Care 2019; 31:572-581. [PMID: 30727749 DOI: 10.1080/09540121.2019.1576841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept involving an individual's self-perception about how a disease or treatment impacts their daily life. In this study, we evaluated the HRQoL and factors associated with this outcome in 366 patients initiating combination Antiretroviral Therapy (cART) in Belo Horizonte, Brazil.We measured HRQoL using the EuroQoL-5D 3 level (EQ-5D) and the HIV instrument of the World Health Organization (WHOQOL-HIV BREF) and identified factors associated with HRQoL using multilevel linear regression. Participants had been on cART treatment a median of 65.5 days at the time the instruments were completed. The median HRQoL of patients on the single-tablet regimen containing efavirenz/ tenofovir/ lamivudine and the multi-tablet regimen containing dolutegravir and tenofovir/ lamivudine were high, with no significant difference between groups. Factors consistently associated with lower HRQoL were being single (unmarried), having a lower educational level, recent cigarette smoking, recent signs and symptoms of anxiety or depression, comorbid disease and the occurrence of adverse drug reactions. We observed high levels of HRQoL in cART-treated people and no differences between dolutegravir and efavirenz-based regimens. This study provides inputs to future economic analysis and identifies opportunities to increase the HRQoL of patients by targeting modifiable factors.
Collapse
Affiliation(s)
- Juliana de Oliveira Costa
- a Programa de Pós-Graduação em Saúde Pública - Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,b Centre for Big Data Research in Health , University of New South Wales , Sydney , Australia
| | - Sallie Anne Pearson
- b Centre for Big Data Research in Health , University of New South Wales , Sydney , Australia
| | - Francisco de Assis Acurcio
- a Programa de Pós-Graduação em Saúde Pública - Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,c Departamento de Farmácia Social - Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Palmira de Fátima Bonolo
- d Departamento de Medicina Preventiva e Social - Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Micheline Rosa Silveira
- c Departamento de Farmácia Social - Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Maria das Graças Braga Ceccato
- c Departamento de Farmácia Social - Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| |
Collapse
|
41
|
Quan P, Yu L, Yang Z, Lei P, Wan C, Chen Y. Development and validation of quality of life instruments for chronic diseases-Chronic gastritis version 2 (QLICD-CG V2.0). PLoS One 2018; 13:e0206280. [PMID: 30427879 PMCID: PMC6235280 DOI: 10.1371/journal.pone.0206280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/10/2018] [Indexed: 01/10/2023] Open
Abstract
Quality of life is an important outcome indicator to evaluate whether treatment is successful or not. Chronic gastritis leads to ongoing deterioration of subjectively perceived quality of life. There are several generic measures, but they are not developed particularly to assess chronic gastritis problems. The Quality of Life Instruments for Chronic Diseases-Chronic Gastritis (QLICD-CG V2.0) questionnaire is a 39-item, multi-dimensional, self-report instrument to assess chronic gastritis patients' perception of their health related quality of life in four domains. The instrument was developed in China. The current study aimed to evaluate the psychometric properties of the QLICD-CG V2.0. 194 patients with chronic gastritis were enrolled from 4 hospitals in China. The QLICD-CG V2.0 was administered to patients by trained research assistants. In addition, their demographic characteristics were also recorded. The psychometric testing included construct validity, convergent validity, discriminant validity, test-retest, and responsiveness. The results showed good internal consistency and acceptable floor and ceiling effects (Cronbach's alpha range from 0.80 to 0.93). CFA showed that the instrument structure has a reasonable fitness (RMSEA = 0.063, 95%CI = [0.057 0.079], CFI = 0.93, GFI = 0.95, SRMR = 0.028). The convergent validity was considered appropriate, with 38 of the 39 items correlated stronger with their assigned scale than a competing scale, except for GPS1. Known groups comparisons showed that the QLICD-CG V2.0 discriminated well between subgroups on the basis of gender, marriage status, and economy status, thus providing evidence of discriminative validity. Convergent validity testing revealed that the QLICD-CG V2.0 domain scores correlated significantly with SF-36 dimension scores, which ranged from 0.21 to 0.58. Test-retest coefficients were satisfactory. A majority of intraclass correlation coefficients were above 0.70, except the psychological domain (0.60) and the items of social support/security (0.61). Responsiveness was tested on 157 patients. Significant differences were found on all QLICD-CG V2.0 domains, between baseline responses and after a treatment, except for the items of appetite and sleep. Robust sensitivity to change was observed. The QLICD-CG V2.0 appears to be a valid and reliable instrument to measure QOL in chronic gastritis patients. Scores were reproducible.
Collapse
Affiliation(s)
- Peng Quan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, CHINA
| | - Lei Yu
- Huadu District, Guangzhou City People's Hospital, Guangzhou, CHINA
| | - Zheng Yang
- School of Public Health, Guangdong Medical University, Dongguan, CHINA
| | | | - Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, CHINA
- * E-mail:
| | - Ying Chen
- School of Public Health, Kunming Medical University, Kunming, CHINA
| |
Collapse
|
42
|
Emuren L, Welles S, Polansky M, Evans AA, Macalino G, Agan BK. Lower health-related quality of life predicts all-cause hospitalization among HIV-infected individuals. Health Qual Life Outcomes 2018; 16:107. [PMID: 29848332 PMCID: PMC5977458 DOI: 10.1186/s12955-018-0931-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQOL) is a patient-centered outcome measure used in assessing the individual's overall functional health status but studies looking at HRQOL as a predictive tool are few. This work examines whether summary scores of HRQOL are predictive of all-cause hospitalization in the US Military HIV Natural History Study (NHS) cohort. METHODS The Short Form 36 (SF-36) was administered between 2006 and 2010 to 1711 NHS cohort members whose hospitalization records we had also obtained. Physical component summary scores (PCSS) and mental component summary scores (MCSS) were computed based on standard algorithms. Terciles of PCSS and MCSS were generated with the upper terciles (higher HRQOL) as referent groups. Proportional hazards multivariate regression models were used to estimate the hazard of hospitalization for PCSS and MCSS separately (models 1 and 2, respectively) and combined (model 3). RESULTS The hazard ratios (HR) of hospitalization were respectively 2.12 times (95% CI: 1.59-2.84) and 1.59 times (95% CI: 1.19-2.14) higher for the lower and middle terciles compared to the upper PCSS tercile. The HR of hospitalization was 1.33 times (95% CI: 1.02-1.73) higher for the lower compared to the upper MCSS tercile. Other predictors of hospitalization were CD4 count < 200 cells/mm3 (HR = 2.84, 95% CI: 1.96, 4.12), CD4 count 200-349 cells/mm3 (HR = 1.67, 95% CI: 1.24, 2.26), CD4 count 350-499 cells/mm3 (HR = 1.41, 95% CI: 1.09, 1.83), plasma viral load > 50 copies/mL (HR = 1.82, 95% CI: 1.46, 2.26), and yearly increment in duration of HIV infection (HR = 0.94, 95% CI: 0.93, 0.96) (model 3). CONCLUSION After controlling for factors associated with hospitalization among those with HIV, both PCSS and MCSS were predictive of all-cause hospitalization in the NHS cohort. HRQOL assessment using the SF-36 may be useful in stratifying hospitalization risk among HIV-infected populations.
Collapse
Affiliation(s)
- Leonard Emuren
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA.
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA.
| | - Seth Welles
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Marcia Polansky
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alison A Evans
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Grace Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
| |
Collapse
|
43
|
A Randomized Trial to Assess the Effect of Doravirine on the QTc Interval Using a Single Supratherapeutic Dose in Healthy Adult Volunteers. Clin Drug Investig 2018; 37:975-984. [PMID: 28785879 DOI: 10.1007/s40261-017-0552-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Doravirine is a novel HIV-1 non-nucleoside reverse transcriptase inhibitor exhibiting a robust safety and efficacy profile in combination with other antiretrovirals. While existing data do not suggest that doravirine delays cardiac repolarization, the aim of this trial was to evaluate the effects of a supratherapeutic dose of doravirine on the heart-rate corrected QT (QTc) interval in healthy adults. METHODS A randomized, three-period, crossover, placebo-controlled trial was conducted in healthy adults, 18-55 years of age. Three treatments were administered: single-dose doravirine 1200 mg, placebo, and positive control (single-dose moxifloxacin 400 mg). QT interval measurements were collected at serial time points following treatment administration. Clinically significant placebo-corrected, baseline-adjusted QTc interval prolongation was defined when the upper bound of the two-sided 90% confidence interval (CI) for the mean effect on double delta QTc exceeded 10 ms. Doravirine tolerability and pharmacokinetics were also evaluated. RESULTS Forty-five subjects were enrolled and 39 completed the study per protocol. Fridericia's QT correction for heart rate was demonstrated to be inadequate; therefore, a population-specific correction was applied (QTcP). Assay sensitivity was confirmed with moxifloxacin. Following doravirine administration, QTc intervals did not exceed the pre-specified significance threshold - upper 90% CIs were ≤5.42 ms across all time points. Categorical analyses identified no outliers or clinically meaningful deviations. Doravirine geometric mean area under the time-concentration curve from dosing until 24 h post-dose (AUC0-24) and maximum plasma concentration (C max) were 119 µM·h and 9240 nM, respectively, which exceeded values expected following therapeutic dose administration of doravirine 100 mg, even in the setting of intrinsic and extrinsic factors that may cause increases in doravirine concentrations. All treatments were generally well tolerated. CONCLUSION A single oral supratherapeutic dose of doravirine 1200 mg does not cause clinically meaningful QTc interval prolongation in healthy adults.
Collapse
|
44
|
Franzese O, Barbaccia ML, Bonmassar E, Graziani G. Beneficial and Detrimental Effects of Antiretroviral Therapy on HIV-Associated Immunosenescence. Chemotherapy 2018; 63:64-75. [PMID: 29533947 DOI: 10.1159/000487534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/06/2018] [Indexed: 02/28/2024]
Abstract
Since the introduction of highly active antiretroviral therapy more than 2 decades ago, HIV-related deaths have dramatically decreased and HIV infection has become a chronic disease. Due to the inability of antiretroviral drugs to eradicate the virus, treatment of HIV infection requires a systemic lifelong therapy. However, even when successfully treated, HIV patients still show increased incidence of age-associated co-morbidities compared with uninfected individuals. Virus- induced immunosenescence, a process characterized by a progressive decline of immune system function, contributes to the premature ageing observed in HIV patients. Although antiretroviral therapy has significantly improved both the quality and length of patient lives, the life expectancy of treated patients is still shorter compared with that of uninfected individuals. In particular, while antiretroviral therapy can contrast some features of HIV-associated immunosenescence, several anti-HIV agents may themselves contribute to other aspects of immune ageing. Moreover, older HIV patients tend to have a worse immunological response to the antiviral therapy. In this review we will examine the available evidence on the role of antiretroviral therapy in the control of the main features regulating immunosenescence.
Collapse
|
45
|
Health-related quality of life of people with HIV: an assessment of patient related factors and comparison with other chronic diseases. AIDS 2018; 32:103-112. [PMID: 29112062 DOI: 10.1097/qad.0000000000001672] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The health-related quality of life (HRQOL) of people with HIV is lower than in the general population, but it is unknown how it compares with that of persons with other chronic medical conditions. We compared HRQOL in HIV with HRQOL in diabetes mellitus type 1, diabetes mellitus type 2 and rheumatoid arthritis (RA). In addition, we investigated factors associated with HRQOL in HIV. DESIGN Cross-sectional study. METHODS HRQOL was measured with the Medical Outcomes Study Short Form 36-item Health Survey in a nationwide sample of people with HIV in care in the Netherlands and on combination antiretroviral therapy for at least 6 months. We added data from studies in diabetes mellitus types 1 and 2, and RA. Logistic regression analysis was used to examine: the association between disease group and a poor HRQOL, and patient factors associated with poor HRQOL in HIV. RESULTS The odds of a poor physical HRQOL in the HIV group were comparable with the odds in diabetes mellitus types 1 and 2, but lower than in RA patients. The odds of a poor mental HRQOL in HIV were higher than in the other groups. In HIV, a history of AIDS, longer duration of combination antiretroviral therapy and severe comorbidity were associated with a poor physical HRQOL. Sub-Saharan African descent and CD4 cell count of less than 350 cells/μl were associated with poor mental HRQOL. CONCLUSION People with HIV were more likely to have a poor mental HRQOL than patients with other chronic conditions. Addressing mental health should be an integral part of outpatient HIV care.
Collapse
|
46
|
A Review of HIV-Specific Patient-Reported Outcome Measures. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:187-202. [PMID: 27637488 DOI: 10.1007/s40271-016-0195-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The use of patient-reported outcome (PRO) measures to provide added feedback to health providers is receiving interest as a means of improving clinical care and patient outcomes, and contributing to more patient-centered care. In human immunodeficiency virus (HIV), while PROs are used in research, their application in clinical practice has been limited despite their potential utility. PRO selection is an important consideration when contemplating their use. As past reviews of PROs in HIV have focused on particular areas (e.g. disability, satisfaction with care), a more comprehensive review could better inform on the available instruments and their scope. This article reviews HIV-specific PROs to produce an inventory and to identify the central concepts targeted over time. Seven databases were searched (HAPI, MEDLINE, PsychINFO, PubMed, EMBASE, CINAHL, Google Scholar), generating 14,794 records for evaluation. From these records, 117 HIV-specific PROs were identified and categorized based on a content analysis of their targeted concept: Health-Related Quality of Life (23; 20 %), ART and Adherence-Related Views and Experiences (19; 16 %), Healthcare-Related Views and Experiences (15; 13 %), Psychological Challenges (12; 10 %), Symptoms (12; 10 %), Psychological Resources (10; 9 %), HIV Self-Management and Self-Care (8; 7 %), HIV-Related Stigma (8; 7 %), Body and Facial Appearance (4; 3 %), Social Support (3; 3 %), Sexual and Reproductive Health (2; 2 %), and Disability (1; 1 %). This review highlights the variety and evolution of HIV-specific PROs, with the arrival of seven categories of PROs only after the advent of highly-active antiretroviral therapy. Our inventory also offers a useful resource. However, the interest of further HIV-specific PRO development should be explored in sexual health, which received little independent attention.
Collapse
|
47
|
Cooper V, Clatworthy J, Harding R, Whetham J. Measuring quality of life among people living with HIV: a systematic review of reviews. Health Qual Life Outcomes 2017; 15:220. [PMID: 29141645 PMCID: PMC5688651 DOI: 10.1186/s12955-017-0778-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022] Open
Abstract
AIM A systematic review of reviews was conducted to identify and appraise brief measures of health-related quality of life (HRQoL) that have been used in peer-reviewed research with people living with HIV. METHODS The review was conducted in two stages: 1) search of electronic databases to identify systematic reviews of tools used to measure HRQoL in adults living with HIV, published since the year 2000; 2) selection of HRQol scales from those identified in the reviews. Inclusion criteria included scales that could be self-administered in 10 min or less, covering at least 3 domains of quality of life (physical function, social/role function and mental/emotional function). For generic scales, inclusion criteria included the availability of normative data while for HIV-specific scales, patient input into the development of the scale was required. RESULTS Ten reviews met the inclusion criteria. Nine generic scales met the inclusion criteria: the EuroQol five dimensions questionnaire (EQ-5D); Health Utilities Index; McGill Quality of Life questionnaire; Medical Outcomes Study (MOS) Short Form (SF)-12; SF-36; World Health Organisation Quality of Life (WHOQOL- BREF), Questions of Life Satisfaction (FLZM) and SF-20. Available psychometric data supported the EQ-5D and SF-36. Seven HIV-specific scales met the inclusion criteria: the AIDS Clinical Trials Group (ACTG)-21; HIV-QL-31; MOS-HIV; Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV), PROQOL-HIV, Symptom Quality of Life Adherence (HIV-SQUAD) and the WHOQOL-HIV BREF. Of the HIV -specific measures, the MOS-HIV was considered to have the most well-established psychometric properties, however limitations identified in the reviews included insufficient input from people living with HIV in the development of the scale, cross-cultural relevance and continued applicability. Two relatively new measures, the WHOQOL-HIV BREF and PROQOL-HIV, were considered to have promising psychometric properties and may have more relevance to people living with HIV. CONCLUSION The findings highlight the need for further validation of HRQoL measures in people living with HIV. The choice of one measure over another is likely to be influenced by the purpose of the quality of life assessment and the domains of HRQoL that are most relevant to the specific research or clinical question.
Collapse
Affiliation(s)
- Vanessa Cooper
- The Lawson Unit, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 1HS UK
| | - Jane Clatworthy
- The Lawson Unit, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 1HS UK
| | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, King’s College London, Faculty of Life Sciences and Medicine, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ UK
| | - Jennifer Whetham
- The Lawson Unit, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 1HS UK
| |
Collapse
|
48
|
de Medeiros RCDSC, de Medeiros JA, da Silva TAL, de Andrade RD, de Medeiros DC, Araújo JDS, de Oliveira AMG, Costa MADA, Dantas PMS. Quality of life, socioeconomic and clinical factors, and physical exercise in persons living with HIV/AIDS. Rev Saude Publica 2017; 51:66. [PMID: 28746573 PMCID: PMC5510782 DOI: 10.1590/s1518-8787.2017051006266] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/14/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS. METHODS This is a cross-sectional exploratory quantitative research, with 227 persons living with HIV/AIDS, treated at two hospitals of reference between April 2012 and June 2014. We used structured questionnaires to assess socioeconomic aspects (gender, age, education level, marital status, race, socioeconomic status, dependents on family income, employment relationship), clinical parameters (time of disease diagnosis, use and time of medication, CD4 T-cell count, and viral load), and practice of physical exercise. To assess quality of life, we used the Quality of Life questionnaire (HAT-QoL). For characterization of the socioeconomic and clinical data and domains of quality of life, we conducted a descriptive analysis (simple frequency, averages, and standard deviations). We applied linear regression, following a hierarchical model for each domain of quality of life. RESULTS The domains that presented lower averages for quality of life were financial concern, concern with confidentiality, general function, and satisfaction with life. We found associations with the variables of socioeconomic status and physical exercise, therapy, and physical exercise for the last two domains, consecutively. CONCLUSIONS The quality of life of persons living with HIV/AIDS shows losses, especially in the financial and confidentiality areas, followed by general function of the body and satisfaction with life, in which socioeconomic and clinical aspects and healthy living habits, such as the practice of physical exercise, are determining factors for this reality. OBJETIVO Analisar se aspectos socioeconômicos, clínicos e de hábitos de vida saudável estão associados à qualidade de vida em pessoas vivendo com HIV/aids. MÉTODOS Pesquisa quantitativa exploratória de corte transversal, com 227 pessoas vivendo com HIV/aids, atendidos em dois hospitais de referência entre os períodos de abril 2012 a junho de 2014. Foram utilizados questionários estruturados para avaliar aspectos socioeconômicos (sexo, idade, escolaridade, estado civil, cor de pele, status socioeconômico, dependentes da renda familiar, vínculo empregatício), parâmetros clínicos (tempo de diagnóstico da doença, uso e tempo de medicação, contagem de células TCD4 e carga viral) e prática de exercício físico. Para avaliar qualidade de vida, utilizou-se o questionário Quality of Life (HAT-QoL). Para caracterização dos dados socioeconômicos, clínicos e domínios da qualidade de vida, conduzimos análise descritiva (frequência simples, médias e desvios-padrão). Aplicamos regressão linear, seguindo um modelo hierárquico para cada domínio da qualidade de vida. RESULTADOS Os domínios que apresentaram menores médias para a qualidade de vida foram preocupação financeira, preocupação com sigilo, função geral e satisfação com a vida. Foram encontradas associações com as variáveis status socioeconômico e exercício físico; terapia; e exercício físico para os dois últimos domínios, consecutivamente. CONCLUSÕES A qualidade de vida de pessoas vivendo com HIV/aids apresentam prejuízos, principalmente nas questões financeiras e de sigilo, seguidos da função geral do corpo e satisfações com a vida, em que os aspectos socioeconômicos, clínicos e hábitos de vida saudável, como a prática de exercício físico, são fatores determinantes para essa realidade.
Collapse
Affiliation(s)
- Rafaela Catherine da Silva Cunha de Medeiros
- Programa de Pós-Graduação em Ciências da Saúde. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
- Curso de Educação Física. Centro Universitário do Rio Grande do Norte. Natal, RN, Brasil
| | | | | | - Ricardo Dias de Andrade
- Programa de Pós-Graduação em Educação Física. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
| | | | - Juliany de Souza Araújo
- Programa de Pós-Graduação em Educação Física. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
| | - Antônio Manuel Gouveia de Oliveira
- Programa de Pós-Graduação em Ciências da Saúde. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
- Departamento de Farmácia. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
| | | | - Paulo Moreira Silva Dantas
- Programa de Pós-Graduação em Ciências da Saúde. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
- Departamento de Educação Física. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
- Programa de Pós-Graduação em Educação Física. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
| |
Collapse
|
49
|
Emuren L, Welles S, Evans AA, Polansky M, Okulicz JF, Macalino G, Agan BK. Health-related quality of life among military HIV patients on antiretroviral therapy. PLoS One 2017; 12:e0178953. [PMID: 28591161 PMCID: PMC5462393 DOI: 10.1371/journal.pone.0178953] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/22/2017] [Indexed: 12/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Leonard Emuren
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
- Public Health Program, South University, Virginia Beach, VA, United States of America
| | - Seth Welles
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Alison A. Evans
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Marcia Polansky
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Jason F. Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, United States of America
| | - Grace Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | | |
Collapse
|
50
|
Lifson AR, Grund B, Gardner EM, Kaplan R, Denning E, Engen N, Carey CL, Chen F, Dao S, Florence E, Sanz J, Emery S. Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS 2017; 31:953-963. [PMID: 28121710 PMCID: PMC5373969 DOI: 10.1097/qad.0000000000001417] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine if immediate compared to deferred initiation of antiretroviral therapy (ART) in healthy persons living with HIV had a more favorable impact on health-related quality of life (QOL), or self-assessed physical, mental, and overall health status. DESIGN QOL was measured in the Strategic Timing of Antiretroviral Therapy study, which randomized healthy ART-naive persons living with HIV with CD4 cell counts above 500 cells/μl from 35 countries to immediate versus deferred ART. METHODS At baseline, months 4 and 12, then annually, participants completed a visual analog scale (VAS) for 'perceived current health' and the Short-Form 12-Item Health Survey version 2 from which the following were computed: general health perception; physical component summary (PCS); and mental component summary (MCS); the VAS and general health were rated from 0 (lowest) to 100 (highest). RESULTS QOL at study entry was high (mean scores: VAS = 80.9, general health = 72.5, PCS = 53.7, MCS = 48.2). Over a mean follow-up of 3 years, changes in all QOL measures favored the immediate group (P < 0.001); estimated differences were as follows: VAS = 1.9, general health = 3.6, PCS = 0.8, MCS = 0.9. When QOL changes were assessed across various demographic and clinical subgroups, treatment differences continued to favor the immediate group. QOL was poorer in those experiencing primary outcomes; however, when excluding those with primary events, results remained favorable for immediate ART recipients. CONCLUSION In an international randomized trial in ART-naive participants with above 500 CD4 cells/μl, there were modest but significant improvements in self-assessed QOL among those initiating ART immediately compared to deferring treatment, supporting patient-perceived health benefits of initiating ART as soon as possible after an HIV diagnosis.
Collapse
Affiliation(s)
- Alan R Lifson
- aUniversity of Minnesota, Minneapolis, Minnesota bDenver Public Health, Denver, Colorado, USA cDesmond Tutu HIV Foundation, Cape Town, South Africa dKirby Institute, University of New South Wales, Sydney, Australia eRoyal Berkshire Hospital, Reading, Berkshire, UK fCentre Universitaire de Recherche Clinique, Bamako, Mali gInstitute of Tropical Medicine, Antwerp, Belgium hHospital Universitario de la Princessa, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|