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Mesías-Gazmuri J, Folch C, Palacio-Vieira J, Bruguera A, Egea-Cortés L, Forero CG, Hernández J, Miró JM, Navarro J, Riera M, Peraire J, Alonso-García L, Díaz Y, Casabona J, Reyes-Urueña J. Syndemic conditions and quality of life in the PISCIS Cohort of people living with HIV in Catalonia and the Balearic Islands: a cross sectional study. Health Qual Life Outcomes 2023; 21:42. [PMID: 37165368 PMCID: PMC10173626 DOI: 10.1186/s12955-023-02120-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND People living with HIV (PLWH) face structural and psychosocial factors that affect health-related quality of life (HRQoL). We aimed to evaluate how syndemic conditions affected HRQoL in PLWH. METHODS A cross-sectional survey was conducted among 861 PLWH, to determine whether syndemic conditions (monthly income; sexual satisfaction; depressive symptoms; social role satisfaction; social isolation; cognitive function; nicotine dependence; perception of stigma) have an effect on HRQoL. A linear regression model and measures of Additive Interaction (AI) were used to determine the effects of syndemic conditions on HRQoL, controlling for other risk factors. RESULTS Overall, the most frequently observed were stigma perception (56.9%), poor cognitive function (50.6%) and the perception of social isolation (51.6%). The presence of depressive symptoms was the risk factor most associated with worse Physical Health (PH) (B 3.93, 2.71-5.15) and Mental Health (MH) (B 5.08, 3.81-6.34) in linear regression model. Specifically, an interaction was observed between poor cognitive function and poor satisfaction with social role on worse PH and MH (AI 2.08, 0.14-4.02; AI 2.69, 0.15-5.22, respectively); and low income and perception of stigma (AI 2.98, 0.26-5.71), low income and perception of social isolation (AI 2.79, 0.27-5.32), and low income and poor satisfaction with social role (AI 3.45, 0.99-5.91) on MH. CONCLUSION These findings provide evidence that syndemic factors impact HRQoL. HIV prevention programs should screen and address co-occurring health problems to improve patient-centered health care and outcomes.
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Affiliation(s)
- Jocelyn Mesías-Gazmuri
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- PhD in Methodology of Biomedical Research and Public Health, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universidad Autonoma de Barcelona, Badalona, Spain
| | - Cinta Folch
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain.
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
| | - Jorge Palacio-Vieira
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Andreu Bruguera
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- PhD in Methodology of Biomedical Research and Public Health, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universidad Autonoma de Barcelona, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Laia Egea-Cortés
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Carlos G Forero
- Department of Medicine. School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - Juan Hernández
- Grupo de Trabajo Sobre Tratamientos del VIH (gTt), Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service. Hospital Clínic-IDIBAPS. University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Navarro
- Infectious Diseases Department. Hospital, Universitari Vall d'Hebron, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | | | - Joaquim Peraire
- Infectious Diseases Department. Hospital, Universitari Vall d'Hebron, Barcelona, Spain
- Hospital Joan XXIII, IISPV, Universitat Rovira I Virgili, Tarragona, Spain
| | - Lucía Alonso-García
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - Yesika Díaz
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Univ Autonoma de Barcelona, Badalona, Spain
| | - Juliana Reyes-Urueña
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Germans Trias I Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
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Michel M, Wahl A, Anders M, Alqahtani SA, Kremer WM, Galle PR, Labenz C, Grimm D, Sprinzl M, Schattenberg JM. Significant liver fibrosis is a predictor of poor health-related quality of life in people living with HIV. Qual Life Res 2023; 32:401-411. [PMID: 35996039 PMCID: PMC9911489 DOI: 10.1007/s11136-022-03232-w] [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] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Liver-related comorbidities can impair the health-related quality of life (HRQL) in people living with human immunodeficiency virus (HIV) (PLWH). However, the role of hepatic steatosis and significant fibrosis in PLWH remains incompletely characterized. Therefore, the aim of this study was to explore the association of hepatic steatosis and significant fibrosis on the HRQL using the medical outcomes study HIV health survey (MOS-HIV) in PLWH. METHODS A total of 222 PLWH were included in the final analysis of this cohort study. Metabolic comorbidities, socioeconomic factors, and HIV-related parameters were assessed. Hepatic steatosis and fibrosis were measured using vibration-controlled transient elastography (VCTE). The MOS-HIV survey, containing two summary scores (physical health summary (PHS) and mental health summary (MHS)) and ten domains, was used to assess the HRQL. Clinical predictors were identified using multivariable linear regression models. RESULTS The majority of this cohort was male, and the median age was 52 years, with a high prevalence of hepatic steatosis (n = 81, 36.5%). Significant fibrosis was present in 7.7% (n = 17). The mean PHS and MHS scores were 52.7 ± 9.5 and 51.4 ± 10.5, respectively. The lowest scores were in the general health perception (GHP) and energy/fatigue (EF) domains. A high BMI and waist circumference were associated with a poor PHS score. Lower education, unemployment, arterial hypertension, and significant fibrosis remained independent predictors of an impaired HRQL. CONCLUSION Metabolic comorbidities, significant fibrosis, and a lower socioeconomic status may negatively affect the HRQL in PLWH. Considering the negative impact of significant fibrosis on the outcome, counseling and preventive measures according to current guidelines are recommended in this subgroup of PLWH.
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Affiliation(s)
- Maurice Michel
- grid.410607.4Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany ,grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Alisha Wahl
- grid.410607.4Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany ,grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Malena Anders
- grid.410607.4Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany ,grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Saleh A. Alqahtani
- grid.415310.20000 0001 2191 4301Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia ,grid.21107.350000 0001 2171 9311Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD USA
| | - Wolfgang M. Kremer
- grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R. Galle
- grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Labenz
- grid.410607.4Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany ,grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Daniel Grimm
- grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin Sprinzl
- grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jörn M. Schattenberg
- grid.410607.4Metabolic Liver Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany ,grid.410607.4I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Fuster-RuizdeApodaca MJ, Sánchez-Vega N, Galindo MJ, Marín-Jimenez I, de Toro J, Orozco-Beltrán D, Cotarelo M, López JC. The Influence of Patient Experience with Healthcare on the Health-Related Quality of Life of People Living with HIV: An Observational Cross-Sectional Survey. Infect Dis Ther 2019; 8:369-382. [PMID: 31290081 PMCID: PMC6702509 DOI: 10.1007/s40121-019-0252-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 01/06/2023] Open
Abstract
Introduction Patient experience is central to the quality of healthcare delivery, showing positive associations with several outcome measures. The main objectives of this study are to analyze the influence of patient experience on the health-related quality of life in people living with HIV and the role played by treatment complexity and clinical care. Methods We conducted a cross-sectional survey with 467 patients with HIV. We used the Instrument for Evaluation of the Experience of Chronic Patients and the Health-related Quality of Life Questionnaire (EQ-5D-5L). We analyzed a predictive model through the partial least squares (PLS) method. Results The patient self-management scores showed the highest positive relationship with the patient’s health-related quality of life (β = 0.24, β = 0.32, p < 0.0001). Patients’ treatment complexity had a negative influence on health-related quality of life (β = − 0.21, β = − 0.28, p < 0.0001). The complexity of clinical care had negative effects on health-related quality of life, both directly (β = − 0.37, β = − 0.19, p < 0.0001) and through its negative influence on the productive interactions with healthcare professionals (β = − 0.21, p < 0.0001) and patient self-management factors (β = − 0.21, p < 0.0001). The effects of patient experience dimensions on their health-related quality of life were higher in people living with HIV > 50 years old (p < 0.05). Conclusions Patient experience mainly influenced the health-related quality of life of older people living with HIV. The treatment and clinical care complexity played an important role in degrading the patients' experience and their quality of life. More integrated care would benefit the health-related quality of life of people living with HIV. Funding This project was funded by Merck Sharp & Dohme, Spain. Electronic supplementary material The online version of this article (10.1007/s40121-019-0252-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - María J Galindo
- Research Department, SEISIDA (Spanish AIDS Multidisciplinary Society), Madrid, Spain.,Internal Medicine Department, Clinic University Hospital, Valencia, Spain
| | - Ignacio Marín-Jimenez
- IBD Unit, Gastroenterology Department Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón Hospital, Madrid, Spain
| | - Javier de Toro
- Rheumatology Department, A Coruña University Hospital, A Coruña, Spain
| | | | - Manuel Cotarelo
- Medical Affairs Department, Merck Sharp and Dohme Spain, Madrid, Spain
| | - Juan Carlos López
- Research Department, SEISIDA (Spanish AIDS Multidisciplinary Society), Madrid, Spain.,HIV Unit, Clinical Microbiology and Infectious Diseases Department, Clinical Research Institute Gregorio Marañón (IiSGM), Gregorio Marañón Hospital, Madrid, Spain
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Dufour C, Gagnon M. [Patient-physician relation: a grounded theory of the experience of HIV treatment side effects.]. Rech Soins Infirm 2019:20-37. [PMID: 29771096 DOI: 10.3917/rsi.132.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Antivirals induce many significant side effects and reduce the quality of life for People Living with HIV (PLWHIV). The management of side effects is crucial to maintain the patient's quality of life and adherence to treatments. The patient-physician relation is essential when managing side effects as it influences the experience for the PLWHIV. This grounded theory analyzes the patient-physician relationship in context with side effects. In the greater Ottawa/Gatineau area, 50 PLWHIV have participated in a semi-structured interview to share their experience with side effects. Four categories were highlighted with this analysis : healthcare model, medical power (central category), strategies and impacts. Results show that physicians are in a monopoly position when taking charge of PLWHIV, who then develop mechanisms of selfpreservation against medical authority. Patients must also develop their own strategies to overcome side effects. Nevertheless, a conflictual relation between patient and physicians may cause multiple devastating effects for the PLWHIV (isolation, withdrawal and distress).
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Wakeham K, Harding R, Levin J, Parkes-Ratanshi R, Kamali A, Lalloo DG. The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study. BMC Palliat Care 2017; 17:8. [PMID: 28705181 PMCID: PMC5508714 DOI: 10.1186/s12904-017-0215-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda. METHODS HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures. RESULTS During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more. CONCLUSION Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes. TRIAL REGISTRATION CRYPTOPRO [ISRCTN 76481529 ], November 2004.
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Affiliation(s)
- Katie Wakeham
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. .,Liverpool School of Tropical Medicine, Liverpool, UK. .,Sussex Cancer Centre, Brighton and Sussex University Hospital, Eastern Road, Brighton, BN2 5DA, UK.
| | - Richard Harding
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Jonathan Levin
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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George S, Bergin C, Clarke S, Courtney G, Codd MB. Health-related quality of life and associated factors in people with HIV: an Irish cohort study. Health Qual Life Outcomes 2016; 14:115. [PMID: 27495166 PMCID: PMC4974803 DOI: 10.1186/s12955-016-0517-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/29/2016] [Indexed: 12/22/2022] Open
Abstract
Background Considering the chronic and debilitating nature of HIV infection, health-related quality of life (HRQoL) is an important patient-reported clinical outcome to better understand the effects of this infection and its treatment on patients’ lives. The purpose of this study was to assess the HRQoL and its association with sociodemographic, behavioural, clinical, nutrition-related factors and social support in an Irish HIV cohort. Methods A cross-sectional, prospective study using the Medical Outcomes Study HIV Health survey assessed the 10 dimensions of HRQoL and summarised as Physical Health Summary (PHS) and Mental Health Summary (MHS) scores. Participants were categorised as having good or poor PHS and MHS using the standardised mean score of 50. The variables independently associated with PHS and MHS were identified using multivariable logistic regression models. Results Overall, 521 participants completed the HRQoL questionnaire. The median (IQR) PHS and MHS scores were 56 (47–60) and 51 (41–58) respectively. All the covariate groups had lower MHS than PHS. Participants with symptoms of HIV reported the lowest median (IQR) PHS score 44.7 (32.–54.5) and MHS score 36.1 (28.6–48.4). Of the 10 dimensions of HRQoL, the lowest scores were for the energy level and general health. Symptoms of HIV, co-morbidities, social support, employment and ethnicity had independent association with both PHS and MHS. Gender, education, alcohol intake and HIV-complications were associated with PHS. Age, illicit drugs, BMI and malnutrition were associated with MHS. However, CD4 count and viral load were not independently associated with PHS and MHS in multivariable regression models. Conclusion Overall, HIV-infected people in this cohort had an average level of HRQoL. However, it is impaired in people with symptoms and co-morbidities, and not independently associated with CD4 and viral load. Alleviating HIV symptoms and preventing co-morbidities are important in managing HIV. Providing psychosocial supports for behaviour modification and return to work or exploring new opportunities will help to improve HRQoL. Healthcare providers and policy makers need to plan and implement programs to routinely assess the HRQoL in a systematic method to facilitate a holistic management of HIV.
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Affiliation(s)
- Sherly George
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland.
| | - Colm Bergin
- GUIDE Clinic, St James's Hospital Dublin, Dublin, Ireland.,Department of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Susan Clarke
- GUIDE Clinic, St James's Hospital Dublin, Dublin, Ireland
| | | | - Mary B Codd
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
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Liamputtong P, Haritavorn N, Kiatying-Angsulee N. Local discourse on antiretrovirals and the lived experience of women living with HIV/AIDS in Thailand. QUALITATIVE HEALTH RESEARCH 2015; 25:253-263. [PMID: 25212858 DOI: 10.1177/1049732314550005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Antiretrovirals (ARVs) have been seen as life-saving for HIV-positive people. However, ARVs have a darker side. Since 2000, many HIV-positive people in Thailand have received ARV treatments, but the understanding of ARVs and practices of medication-taking among HIV-positive women have not received much attention. We discuss local discourses employed by HIV-positive women and health work by these individuals in their attempts to adhere to ARVs restrictions. The local discourse of ARVs was ya tan rok AIDS "medications that could resist HIV/AIDS." ARVs provided hope for the women. Although the women were affected by the side effects of ARVs, they continued to take their medication to be able to live longer and perform their duties as mothers and carers. They were more concerned about the practice of medication-taking. Understanding why these women were adherent to their ARVs offers insights into the social impact of these ARVs on their lives.
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Degroote S, Vogelaers D, Vandijck DM. What determines health-related quality of life among people living with HIV: an updated review of the literature. ACTA ACUST UNITED AC 2014; 72:40. [PMID: 25671112 PMCID: PMC4323115 DOI: 10.1186/2049-3258-72-40] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 08/13/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND As infection with the Human Immunodeficiency Virus (HIV) has evolved to a chronic disease, perceived health-related quality of life (HRQoL) is becoming a prominent and important patient-reported outcome measure in HIV care. Literature discusses different factors influencing HRQoL in this population, however, currently no consensus exists about the main determinants. In this review a clear, up-to-date overview of the determinants influencing HRQOL among people living with HIV is provided. METHODS All studies published before July 2013 that identified determinants of HRQoL among people living with HIV in high-income countries, were considered in this narrative review. PubMed, Web of Science and The Cochrane Library were consulted using the keywords 'determinants', 'quality of life', 'HIV' and 'AIDS'. To be included, studies should have reported overall health and/or physical/mental health scores on a validated instrument and performed multivariable regression analyses to identify determinants that independently influence perceived HRQoL. RESULTS In total, 49 studies were included for further analysis and they used a variety of HRQoL instruments: Medical Outcomes Study Short Form-36 or variants, Medical Outcomes Study-HIV, HIV Cost and Services Utilization Study measure, Multidimensional Quality of Life Questionnaire, HIV targeted quality of life instrument, Functional Assessment of Human Immunodeficiency Virus Infection, HIV Overview of Problems Evaluation System, EuroQol, Fanning Quality of Life scale, Health Index and PROQOL-HIV. In this review, the discussed determinants were thematically divided into socio-demographic, clinical, psychological and behavioural factors. Employment, immunological status, presence of symptoms, depression, social support and adherence to antiretroviral therapy were most frequently and consistently reported to be associated with HRQoL among people living with HIV. CONCLUSIONS HRQoL among people living with HIV is influenced by several determinants. These determinants independently, but simultaneously impact perceived HRQoL. Most HRQoL instruments do not capture all key determinants. We recommend that the choice for an instrument should depend on the purpose of the HRQoL assessment.
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Affiliation(s)
- Sophie Degroote
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dominique M Vandijck
- Department of General Internal Medicine, Infectious Diseases and Psychosomatics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium ; Department of Economics, Faculty of Business Economics, Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium
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Greeff M, Chepuka LM, Chilemba W, Chimwaza AF, Kululanga LI, Kgositau M, Manyedi E, Shaibu S, Wright SCD. Using an innovative mixed method methodology to investigate the appropriateness of a quantitative instrument in an African context: Antiretroviral treatment and quality of life. AIDS Care 2013; 26:817-20. [PMID: 24266385 DOI: 10.1080/09540121.2013.859651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationship between quality of life (QoL) and antiretroviral treatment (ART) has mainly been studied using quantitative scales often not appropriate for use in other contexts and without taking peoples' lived experiences into consideration. Sub-Saharan Africa has the highest incidence of HIV and AIDS yet there is paucity in research done on QoL. This research report is intended to give an account of the use of a mixed method convergent parallel design as a novice approach to evaluate an instrument's context specificity, appropriateness and usefulness in another context for which it was designed. Data were collected through a qualitative exploration of the experiences of QoL of people living with HIV or AIDS (PLHA) in Africa since being on ART, as well as the quantitative measurements obtained from the HIV/AIDS-targeted quality of life (HAT-QoL) instrument. This study was conducted in three African countries. Permission and ethical approval to conduct the study were obtained. Purposive voluntary sampling was used to recruit PLHA through mediators working in community-based HIV/AIDS organisations and health clinics. Interviews were analysed through open coding and the quantitative data through descriptive statistics and the Cronbach's alpha coefficient. A much wider range and richness of experiences were expressed than measured by the HAT-QoL instrument. Although an effective instrument for use in the USA, it was found not to be sensitive, appropriate and useful in an African context in its present form. The recommendations focus on adapting the instrument using the data from the in-depth interviews or to develop a context-sensitive instrument that could measure QoL of PLHA in Africa.
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Affiliation(s)
- Minrie Greeff
- a African Unit for Transdisciplinary Health Research , North-West University Potchefstroom Campus , South Africa
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10
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Keltner JR, Vaida F, Ellis RJ, Moeller-Bertram T, Fitzsimmons C, Duarte NA, Robinson-Papp J, Dworkin RH, Clifford DB, McArthur JC, Simpson DM, Collier AC, Marra CM, Atkinson JH, Grant I. Health-related quality of life 'well-being' in HIV distal neuropathic pain is more strongly associated with depression severity than with pain intensity. PSYCHOSOMATICS 2012; 53:380-6. [PMID: 22748751 DOI: 10.1016/j.psym.2012.05.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/27/2012] [Accepted: 04/30/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite modern antiretroviral treatment, HIV-associated distal neuropathic pain (DNP) remains one of the most prevalent and debilitating complications of HIV disease. Neuropathic pain is often accompanied by depressed mood, and both pain and depression have been associated with decreased health-related quality of life (HRQOL) well-being. The relative contribution of depression and pain to worse life quality has not been addressed, however, even though a better understanding might sharpen intervention strategies. METHODS We used the Medical Outcomes Study HIV (MOS-HIV) Health Survey and the Beck depression inventory-II and linear regression models to investigate HRQOL well-being in HIV-infected patients with DNP (n = 397) participating in an observational cohort study at six U.S. sites (CNS HIV Antiretroviral Treatment Effects Research Study, CHARTER). RESULTS For this sample of patients with HIV DNP, severity of depressed mood was more highly correlated with HRQOL well-being than was pain intensity. CONCLUSIONS These results suggest that interventions to improve HRQOL well-being in individuals with HIV-associated DNP may need to address not only pain intensity but mood state as well.
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Affiliation(s)
- John R Keltner
- Department of Psychiatry, University of California-San Diego, San Diego, CA 92117, USA.
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Arrivillaga M, Springer AE, Lopera M, Correa D, Useche B, Ross MW. HIV/AIDS treatment adherence in economically better off women in Colombia. AIDS Care 2012; 24:929-35. [DOI: 10.1080/09540121.2011.647678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Marcela Arrivillaga
- a Department of Public Health & Epidemiology, Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Cali , Colombia
| | - Andrew E. Springer
- b Michael & Susan Dell Center for Advancement of Healthy Living , University of Texas School of Public Health-Austin Regional Campus , Austin , TX , USA
| | - Monica Lopera
- c National Faculty of Public Health , University of Antioquia , Medellín , Colombia
| | - Diego Correa
- d Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Cali , Colombia
| | - Bernardo Useche
- e Associate Researcher Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Colombia
| | - Michael W. Ross
- f Center for Health Promotion and Prevention Research, School of Public Health Houston , University of Texas , Houston , TX , USA
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Briongos Figuero LS, Bachiller Luque P, Palacios Martín T, González Sagrado M, Eiros Bouza JM. Assessment of factors influencing health-related quality of life in HIV-infected patients. HIV Med 2011; 12:22-30. [PMID: 20497251 DOI: 10.1111/j.1468-1293.2010.00844.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Health-related quality of life (HRQL) is used in the assessment of chronic illness. Regarding HIV infection, HRQL assessment is an objective for physicians and institutions since antiretroviral treatment delays HIV clinical progression. The aim of this study was to determine the factors with the most influence on HRQL in HIV-infected people and to create a predictive model. METHODS We conducted a cross-sectional study in 150 patients in a tertiary hospital. HRQL data were collected using the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. The research team created a specific template with which to gather clinical and sociodemographic data. Adherence was assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. Logistic regression models were used to identify determinants of HRQL. RESULTS HIV-related symptoms and presence of depression were found to be negatively associated with all the MOS-HIV domains, the Physical Health summary score and the Mental Health summary score. Patients receiving protease inhibitor (PI)-based treatment had lower scores in four of the 11 domains of the MOS-HIV questionnaire. Gender, hospitalization in the year before enrolment, depression and parenthood were independently related to the Physical Health Score; depression and hepatitis C virus coinfection were related to the Mental Health Score. CONCLUSIONS Optimization of HRQL is particularly important now that HIV infection can be considered a chronic disease with the prospect of long-term survival. Quality of life should be monitored in follow-up of HIV-infected patients. The assessment of HRQL in this population can help us to detect problems that may influence the progression of the disease. This investigation highlights the importance of a multidisciplinary approach to HIV infection.
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Affiliation(s)
- L S Briongos Figuero
- Internal Medicine Department, Rio Hortega University Hospital, Valladolid, Spain.
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Briongos-Figuero LS, Bachiller-Luque P, Palacios-Martín T, de Luis-Román DA, Eiros-Bouza JM. [Factors associated with antiretroviral treatment and their influence on health related quality of life in HIV infected patients]. Enferm Infecc Microbiol Clin 2011; 29:9-13. [PMID: 21208696 DOI: 10.1016/j.eimc.2010.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 03/09/2010] [Accepted: 06/09/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Access to antiretroviral treatment (ART) has become essential to delay HIV clinical progression and increase survival, so improving Health Related Quality of Life (HRQL). The aim of this investigation was to describe factors associated with ART and their impact on HRQL in HIV infected patients. METHODS A cross-sectional study on 150 HIV-outpatients in a tertiary hospital was designed, and ART-related data collected. Adherence was assessed by the SMAQ questionnaire. HRQL data were collected by disease-specific questionnaire MOS-HIV (Medical Outcomes Study HIV Health Survey). RESULTS A total of 84% of patients were on ART. Half of the treatment regimens were Protease inhibitor (PI) based, LPV/r being the most commonly used drug. The large majority of treatments used (89.7%) were second line or successive, and NNRTI-based combinations were the most used in first line. Lipodystrophy was the most frequently referred side-effect (61.1%). Almost all (94.5%) of our patients declared they were adapting well to treatment in their daily-life-activities, with 64.3% adhering to treatment according to the SMAQ (Simplified Medication Adherence Questionnaire) questionnaire. In the HRQL, patients with PI-based treatment got lower scores in 4 of 11 domains with the MOS-HIV questionnaire; while patients that adapted well to their ART had better scores in 4 of 11 domains and overall HRQL assessment in MOS-HIV. CONCLUSIONS Most of our patients were on ART during our investigation. We have documented a negative association between PI-based treatment and HRQL domains, and a positive association between subjective ART adaptation and HRQL. The assessment of HRQL in this population has increasing interest as it is influenced by ART related factors as treatment improves life conditions of HIV infected people.
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Affiliation(s)
- Laisa Socorro Briongos-Figuero
- Medicina Familiar y Comunitaria, Servicio de Medicina Interna, Hospital Universitario del Río Hortega, Valladolid, España.
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Gastrointestinal tolerability and quality of life in antiretroviral-naive HIV-1-infected patients: data from the CASTLE study. AIDS Care 2010; 22:677-86. [PMID: 20467943 DOI: 10.1080/09540120903334641] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Most ritonavir-boosted protease inhibitor (PI)-based antiretroviral regimens offer comparable levels of virological efficacy. Thus, the tolerability of the regimen becomes a distinguishing factor with implications for patient quality of life (QoL), treatment adherence, and clinical outcome. This article describes results from the CASTLE study (comparing once-daily atazanavir/ritonavir [ATV/RTV] with twice-daily lopinavir/ritonavir [LPV/RTV], both in combination with fixed-dose tenofovir/emtricitabine, in treatment-naive HIV-infected patients) and an evaluation of the impact of gastrointestinal (GI) complications of treatment on patient QoL, as measured by the irritable bowel syndrome (IBS) QoL questionnaire (IBS-QoL). Changes in IBS-QoL from baseline over time (to week 24) were classified as: "Improvement" (> or =2-point positive change from baseline), "No change" (<2-point change), or "Worsening" (> or =2-point negative change). Data were collected on GI adverse events (AEs) and use of GI medications. Of the 599 patients with IBS-QoL-evaluable data through week 24, fewer patients in the ATV/RTV group than in the LPV/RTV group experienced grade 2-4 treatment-related GI AEs including diarrhea (3% versus 10%), nausea (5% versus 7%), and vomiting (<1% on both arms). Nearly three times as many patients receiving LPV/RTV used GI medications. ATV/RTV was associated with an increase in overall IBS-QoL scores and more patients receiving ATV/RTV than LPV/RTV experienced improvement in IBS-QoL through week 24. In contrast to LPV/RTV, ATV/RTV treatment was associated with earlier and more positive improvements in QoL scores across CD4 sub-groups. Differences in the health-related QoL profile between ATV/RTV and LPV/RTV may be important when selecting PI-based antiretroviral regimens.
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Wouters E, Van Loon F, Van Rensburg D, Meulemans H. State of the ART: clinical efficacy and improved quality of life in the public antiretroviral therapy program, Free State province, South Africa. AIDS Care 2010; 21:1401-11. [PMID: 20024717 DOI: 10.1080/09540120902884034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The South African public-sector antiretroviral treatment (ART) program has yielded promising early results. To extend and reinforce these preliminary findings, we undertook a detailed assessment of the clinical efficacy and outcomes over two years of ART. The primary objective was to assess the clinical outcomes and adverse effects of two years of ART, while identifying the possible effects of baseline health and patient characteristics. A secondary objective was to address the interplay between positive and negative outcomes (clinical benefits versus adverse effects) in terms of the patients' physical and emotional quality of life (QoL). Clinical outcome, baseline characteristics, health status, and physical and emotional QoL scores were determined from clinical files and interviews with 268 patients enrolled in the Free State ART program at three time points (6, 12, and 24 months of ART). Age, sex, education, and baseline health (CD4 cell count and viral load) were all independently associated with the ART outcome in the early stages of treatment, but their impact diminished as the treatment progressed. The number of patients classified as treatment successes increased over the first two years of ART, whereas the proportion of patients experiencing adverse effects diminished. Importantly, our findings show that ART had strong and stable positive effects on physical and emotional QoL. These favorable results demonstrate that a well-managed public-sector ART program can be very successful within a high-HIV-prevalence resource-limited setting. This finding emphasizes the need to adopt treatment scale-up as a key policy priority, while at the same time ensuring that the highest standards of healthcare provision are maintained. Healthcare services should also target vulnerable groups (males, less-educated patients, those with low baseline CD4 cell counts, and high baseline viral loads) who are most likely to experience treatment failure.
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Affiliation(s)
- E Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium.
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Langius-Eklöf A, Lidman K, Wredling R. Health-related quality of life in relation to sense of coherence in a Swedish group of HIV-infected patients over a two-year follow-up. AIDS Patient Care STDS 2009; 23:59-64. [PMID: 19063712 DOI: 10.1089/apc.2008.0076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of the present study was to describe HIV-infected patients' self-reported health-related quality of life (HRQOL) in relation to sense of coherence over a 24-month period. A total of 104 HIV-infected patients (71% males) answered questionnaires at three times at 12-month intervals. At the same time, clinical characteristics were collected from the patients' medical records. HRQOL was measured by the HIV-symptom scale, the Health Index, and the Well-Being Scale. Coping ability was measured with the 29-item sense of coherence (SOC) scale. The patients were divided into three groups depending on SOC scores (low, moderate, high). The results indicate that the group with low SOC scores rate their HRQOL worse than the other groups at all three measurements (p values from <0.05 to <0.001). Over the 2-year period, the patients' CD4 cell count=mm3 increased significantly (p values <0.001), indicating good response to antiretroviral treatment. However, their HRQOL did not improve during these 2 years. Patients with higher SOC rate their HRQOL better than those with a lower SOC, during these years. Future studies should investigate the predictive value of the SOC scale of HRQOL in HIV-infected patients.
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Affiliation(s)
- Ann Langius-Eklöf
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Knut Lidman
- Department of Infectious Diseases, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Regina Wredling
- Department of Neurobiology, Care Sciences and Society and the Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
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