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

Dutra, Brenda Soares; Lédo, Ana Paula; Lins-Kusterer, Liliane; Luz, Estela; Prieto, Indira Rodriguez; Brites, Carlos

doi:10.1016/j.bjid.2019.06.005

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Brazilian Journal of Infectious Diseases

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Original Articles • Braz J Infect Dis 23 (4) • Jul-Aug 2019 • https://doi.org/10.1016/j.bjid.2019.06.005 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

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

Objective:

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

Methods:

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

Results:

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

Conclusions:

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

Keywords:
Health-related quality of life; Antiretroviral Therapy; HIV; Patient Reported Outcome Measures

Demographic and clinical characteristics	N (%)
Sex
Male	71 (78.0)
Female	20 (22.0)
Education (Years)
<8	19 (20.9)
≥8	72 (79.1)
Race/ Ethnicity
Caucasian	19 (20.9)
Racially mixed	55 (60.4)
Black	17 (18.7)
Family income (Minimal Wages)^a a Family income (Minimal Wages): 284.6 USD.
<1 MW	41 (45.1)
≥1 MW	50 (54.9)
Marital status
Single	18 (19.8)
Married/stable relationship	73 (80.2)
Living
Alone	32 (35.2)
With Family	51 (56.0)
With Friends	8 (8.8)
Charlson's comorbidity index^b b Charlson's comorbidity index score: No: 0; Mild: 1-2; Moderate: 3-5, severe: >5.
No	67 (73.6)
Mild	17 (18.7)
Moderate	6 (6.6)
Severe	1 (1.1)
Body mass index (kg/m²[2] Miners A, Phillips A, Kreif N, Rodger A, Speakman A, Fisher M, et al. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV. 2014;1:e32-40.)
Underweight <18,5	7 (7.7)
Normal weight. = 18,5-25	57 (62.6)
Over weight ≥25 - <30	21 (23.1)
Obese ≥30	6(6.6)

SF-36 Domains and Component Summaries	Before ART	Cronbach's Alpha	After 1 year of ART	Cronbach's Alpha	p-value^a a t-student for paired samples.
Physical Functioning (PF)	49.3 ± 11.0	0.93	51.4 ± 8.9	0.94	0.0001
Role Physical (RP)	45.1 ± 12.6	0.95	44.3 ± 13.2	0.98	0.580
Bodily Pain (BP)	52.0 ± 12.3	0.76	53.9 ± 10.6	0.82	0.117
General Health (GH)	47.5 ± 10.6	0.68	51.8 ± 10.2	0.85	0.0001
Vitality (VT)	50.7 ± 11.9	0.77	51.0 ± 12.4	0.85	0.840
Social Functioning (SF)	43.6 ± 12.0	0.65	50.0 ± 8.4	0.69	0.0001
Role Emotional (RE)	40.3 ± 14.3	0.92	41.5 ± 15.1	0.97	0.471
Mental Health (MH)	43.4 ± 13.4	0.79	47.3 ± 12.1	0.81	0.0001
Physical Component Summary (PCS)	51.4 ± 10.2	_	52.5 ± 7.9	_	0.146
Mental Component Summary (MCS)	42.0 ± 13.0	_	45.2 ± 11.0	_	0.004

HAT-QoL Domains	Before ART	Cronbach's Alpha	After 1 year of ART	Cronbach's Alpha	p-value^a a t-student for paired samples.
Overall Function	58.8 ± 27.2	0.80	71.0 ± 23.2	0.84	0.0001
Life Satisfaction	53.1 ± 29.2	0.79	68.2 ± 29.0	0.89	0.0001
Health worries	41.8 ± 31.1	0.82	47.0 ± 29.6	0.90	0.132
Financial Worries	45.7 ± 39.6	0.91	41.7 ± 37.1	0.95	0.292
Medication Concerns	_	_	65.4 ± 15.1	0.84	_
HIV Mastery	41.2 ± 37.0	0.83	41.5 ± 36.7	0.92	0.941
Disclosure Worries	28.3 ± 26.0	0.70	13.3 ± 21.2	0.72	0.0001
Provider Trust	78.8 ± 26.0	0.82	82.0 ± 19.7	0.87	0.0001
Sexual Function	59.2 ± 36.9	0.79	79.3 ± 33.3	0.96	0.0001

	PCS^* (R²[2] Miners A, Phillips A, Kreif N, Rodger A, Speakman A, Fisher M, et al. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV. 2014;1:e32-40. = 37%)			MCS** (R²[2] Miners A, Phillips A, Kreif N, Rodger A, Speakman A, Fisher M, et al. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV. 2014;1:e32-40. = 25%)
Variables	B	SE_B	p-value^*	B	SE_B	p-value^*
Constant	56.504	5.150	.000	40.800	7.952	.000
Sex (male)	4.002	1.787	.028	9.044	2.759	.002
Age, years	-.284	.067	.001	-.169	.104	.107
Family income***	.002	.001	.007	.001	.001	.100
BMI****	-.197	.178	.272	-.191	.275	.489
Stable relationship	5.188	1.767	.004	5.752	2.728	.038

Domain	PF	RP	BP	GH	VT	SF	RE	MH	PCS	MCS
Overall function	0.77^b b Correlation is significant at the 0.05 level (2-tailed).	0.66^b b Correlation is significant at the 0.05 level (2-tailed).	0.55^b b Correlation is significant at the 0.05 level (2-tailed).	0.71^b b Correlation is significant at the 0.05 level (2-tailed).	0.70^b b Correlation is significant at the 0.05 level (2-tailed).	0.61^b b Correlation is significant at the 0.05 level (2-tailed).	0.62^b b Correlation is significant at the 0.05 level (2-tailed).	0.63^b b Correlation is significant at the 0.05 level (2-tailed).	0.81^b b Correlation is significant at the 0.05 level (2-tailed).	0.72^b b Correlation is significant at the 0.05 level (2-tailed).
Life satisfaction	0.54^b b Correlation is significant at the 0.05 level (2-tailed).	0.47^b b Correlation is significant at the 0.05 level (2-tailed).	0.41^b b Correlation is significant at the 0.05 level (2-tailed).	0.67^b b Correlation is significant at the 0.05 level (2-tailed).	0.62^b b Correlation is significant at the 0.05 level (2-tailed).	0.57^b b Correlation is significant at the 0.05 level (2-tailed).	0.44^b b Correlation is significant at the 0.05 level (2-tailed).	0.52^b b Correlation is significant at the 0.05 level (2-tailed).	0.59^b b Correlation is significant at the 0.05 level (2-tailed).	0.64^b b Correlation is significant at the 0.05 level (2-tailed).
Health worries	0.37^b b Correlation is significant at the 0.05 level (2-tailed).	0.42^b b Correlation is significant at the 0.05 level (2-tailed).	0.29^b b Correlation is significant at the 0.05 level (2-tailed).	0.45^b b Correlation is significant at the 0.05 level (2-tailed).	0.52^b b Correlation is significant at the 0.05 level (2-tailed).	0.41^b b Correlation is significant at the 0.05 level (2-tailed).	0.41^b b Correlation is significant at the 0.05 level (2-tailed).	0.52^b b Correlation is significant at the 0.05 level (2-tailed).	0.39^b b Correlation is significant at the 0.05 level (2-tailed).	0.58^b b Correlation is significant at the 0.05 level (2-tailed).
Financial worries	0.52^b b Correlation is significant at the 0.05 level (2-tailed).	0.63^b b Correlation is significant at the 0.05 level (2-tailed).	0.32^b b Correlation is significant at the 0.05 level (2-tailed).	0.45^b b Correlation is significant at the 0.05 level (2-tailed).	0.45^b b Correlation is significant at the 0.05 level (2-tailed).	0.34^b b Correlation is significant at the 0.05 level (2-tailed).	0.62^b b Correlation is significant at the 0.05 level (2-tailed).	0.46^b b Correlation is significant at the 0.05 level (2-tailed).	0.54^b b Correlation is significant at the 0.05 level (2-tailed).	0.58^b b Correlation is significant at the 0.05 level (2-tailed).
Medication Concerns	0.15	0.29^b b Correlation is significant at the 0.05 level (2-tailed).	0.18	0.26^a a Correlation is significant at the 0.01 level (2-tailed).	0.16	0.30^b b Correlation is significant at the 0.05 level (2-tailed).	0.33^b b Correlation is significant at the 0.05 level (2-tailed).	0.31^b b Correlation is significant at the 0.05 level (2-tailed).	0.19	0.37^b b Correlation is significant at the 0.05 level (2-tailed).
HIV mastery	0.27	0.18	0.21^a a Correlation is significant at the 0.01 level (2-tailed).	0.43^b b Correlation is significant at the 0.05 level (2-tailed).	0.35^b b Correlation is significant at the 0.05 level (2-tailed).	0.25^a a Correlation is significant at the 0.01 level (2-tailed).	0.20	0.42^b b Correlation is significant at the 0.05 level (2-tailed).	0.26^a a Correlation is significant at the 0.01 level (2-tailed).	0.38^b b Correlation is significant at the 0.05 level (2-tailed).
Disclosure worries	0.01	-0.15	0.08	-0.14	0.07	0.04	-0.16	0.07	-0.06	-0.01
Provider Trust	-0.07	0.15	0.02	0.13	-0.03	0.06	0.15	0.03	0.03	0.10
Sexual Function	0.50^b b Correlation is significant at the 0.05 level (2-tailed).	0.35^b b Correlation is significant at the 0.05 level (2-tailed).	0.31^b b Correlation is significant at the 0.05 level (2-tailed).	0.45^b b Correlation is significant at the 0.05 level (2-tailed).	0.52^b b Correlation is significant at the 0.05 level (2-tailed).	0.44^b b Correlation is significant at the 0.05 level (2-tailed).	0.30^b b Correlation is significant at the 0.05 level (2-tailed).	0.54^b b Correlation is significant at the 0.05 level (2-tailed).	0.45^b b Correlation is significant at the 0.05 level (2-tailed).	0.52^b b Correlation is significant at the 0.05 level (2-tailed).

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[1] * Corresponding author at: LAPI - Research Laboratory of Infectious Diseases, Edgard Santos Federal University Hospital, Federal University of Bahia. Rua Augusto Viana, S/n, Canela, Salvador, Bahia CEP-40110060, Brazil. E-mail addresses: brendasdutra@hotmail.com(B.S. Dutra), anapaulaledo3@gmail.com (A.P. Lédo), liliane.lins@ufba.br br(L. Lins-Kusterer), eluz5@yahoo.com.br (E. Luz), indira.rodriguez70@gmail.com (I.R. Prieto), crbrites@gmail.com (C. Brites).