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People living with HIV in the UK still have impaired health-related quality of life
Michael Carter, 2014-04-22 10:10:00
People living with HIV in the UK have poorer health-related quality of life (HRQoL) compared to individuals in the general population, according to research presented at the recent BHIVA BASHH conference.
The study compared the results of two separate HRQoL surveys, one involving HIV-positive adults, the other adults in the general UK population. Both were conducted between 2010 and 2011. The surveys measured five key aspects of HRQoL. Patients with HIV were more likely to report problems for each of these. HIV continued to be associated with poorer HRQoL when the investigators controlled for confounding factors and restricted their analysis to HIV-positive patients taking antiretroviral therapy with an undetectable viral load.
They believe their findings show the excess burden of ill health that continues to be associated with HIV infection, even among people taking effective therapy.
There is a growing body of research showing that patients taking HIV therapy in richer countries like the UK now have a normal life expectancy.
However, much less is known about the HRQoL of HIV-positive patients in the modern treatment era.
A team of UK investigators therefore designed a study comparing HRQoL between HIV-positive patients and HIV-negative individuals in the background UK population.
The HIV-positive population comprised 3,151 outpatients living with HIV recruited to the ASTRA study. The HSE study contributed 7,424 individuals for the comparative HIV-negative group.
Both studies measured five aspects of HRQoL: mobility; self-care; ability to perform usual activities such as work, study, housework, family or leisure activities; pain/discomfort; and anxiety/depression. Answers were used to calculate a score to indicate overall HRQoL.
The majority (95%) of HIV-positive patients had a CD4 count above 200 cells/mm3 and three-quarters were taking antiretroviral therapy with an undetectable viral load.
There were significant differences between the HIV-positive and HIV-negative patients. Individuals with HIV were younger (median age 45 vs. 49 years), more likely to be male (81% vs. 43%) and MSM (67% vs. 1%) and to be smokers (30% vs. 26%). However, patients with HIV were less likely to report heavy drinking (10% vs. 20%), be in employment (58% vs. 62%) or be of white race (81% vs. 91%) (all comparisons significant, p < 0.05).
A higher proportion of patients with HIV than individuals in the general population reported problems with each of the five measures of HRQoL.
Mobility: 27% vs. 20%
Self-care: 13% vs. 5%
Usual activities: 34% vs. 21%
Pain: 42% vs. 40%
Anxiety/depression: 50% vs. 42%
All these differences were significant (p < 0.05).
Patients with HIV also had a significantly lower overall HRQoL utility score (0.74 vs. 0.82).
HIV was associated with poorer HRQoL even after the investigators took into account factors such as age, gender, ethnicity and smoking status (p < 0.001). The association between HIV and poorer HRQoL also persisted when analysis was restricted to patients with a competent immune system and those with an undetectable viral load under antiretroviral therapy (p < 0.001).
Other factors associated with poorer HRQoL included older age, gender (female vs. MSM), smoking, lower levels of educational achievement (all p < 0.001) and non-white ethnicity (p = 0.01).
The investigators therefore conclude that patients with HIV have poorer HRQoL than individuals in the general population. They also believe their findings show HIV infection continues to be associated with an excess burden of ill health in the era of effective therapy.
Source:1
