Effect of long-cycle structured intermittent versus continuous HAART on quality of life in patients with chronic HIV infection (original) (raw)
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Changes in quality-of-life perceptions and their relations to clinical status for 41 adult outpa- tients living with HIV/AIDS were assessed over a 4-year period. Clinical variables and quality- of-life (Medical Outcomes Study Short-Form-36) ratings were measured in three waves (T1, 1997; T2, 1999; T3, 2001). Mean T1–T3 CD4 increase was 196 cells/μL ( p < .0001), corre- sponding to a mean viral load reduction of 1.4 log10 copies/mL ( p < .0001) and an increase in proportions with “undetectable” viral load status from 32% to 61% ( p < .01). The T1–T2 increase in overall mean number of symptoms (including both disease–related symptom com- plex and treatment side effects) was mitigated by T2–T3 symptom reduction. Quality-of-life dimensions were generally stable or slightly improved over time for the overall sample, a find- ing that contrasts with pre-highly active antiretroviral therapy longitudinal research. Mental aspects of quality of life remained consistently lower than reference norms. Results of multiple regression suggested that quality of life was less sensitive to immunologic/virologic changes compared to responsiveness to symptom changes, consistent with cross-sectional inverse re- lations between symptom burden and quality of life. CD4 repletion offset negative effects of symptoms for some aspects of quality of life. The long-term course of quality of life was some- what predicted by viral load suppression due to the conjoint influence of symptoms and CD4 count.
Quality of Life Research, 2006
Patient-centered measures of functioning and well-being are needed to monitor and improve health for HIV-infected persons. We estimated the associations between HRQOL and symptoms over time in HIVinfected persons, adjusting for demographic and clinical characteristics using a longitudinal study of a nationally representative cohort of 2267 patients in care for HIV infection surveyed in 1996 and again in 1998. We used two global measures of HRQOL (overall health and overall quality of life) scored to have a mean of 50 and standard deviation of 10 in the sample. The total number of symptoms decreased ()1.29, p<0.001 for the difference), and overall health (1.09, p<0.001 for the difference) and overall quality of life (1.31, p<0.001 for the difference) improved over the period. Controlling for baseline symptoms and HRQOL, each additional symptom at follow-up (B=)1.14, p<0.001) was associated with worsened overall health and worsened overall quality of life (B=)0.95, p<0.001). The association of two additional symptoms with lower global HRQOL was similar in magnitude to the effect of having significant depressive symptoms or the diagnosis of AIDS. In conclusion, among HIV-infected patients, symptoms are significantly related to HRQOL over time. The functioning and well-being of patients with HIV is inextricably linked to the symptoms they experience.
Impacts of HIV infection and HAART use on quality of life
Quality of Life Research, 2006
Background: Studies have shown the detrimental effect of HIV disease on quality of life (QOL). Changes in QOL related to the use of highly active antiretroviral therapy (HAART) have been inconsistent and it is unknown how QOL after HAART compares to pre-infection levels. Objective: The objective of this study was to determine the impacts of becoming HIV infected and using HAART on QOL within individuals followed in the Multicenter AIDS Cohort Study (MACS). Methods: Using the standard Medical Outcome Study SF-36 form, QOL data were collected pre-seroconversion, post-seroconversion but before HAART initiation, and after HAART initiation for 68 seroconverters. The QOL physical health summary score (PHS) and mental health summary score (MHS) were used as outcomes. The effects of HIV infection and HAART use on QOL summary scores were determined using random effects mixed linear models after controlling for possible confounders. The clinical significance of QOL change was assessed using the Cohen’s effect size method. Results: Compared to pre-seroconversion values, the PHS decreased after seroconversion (mean difference (diff) = −1.62; 95% confidence interval (CI): [−3.20, −0.03]) and after HAART initiation (diff = −4.20; 95% CI: [−5.86, −2.54]) with small to medium effect sizes. The score remained significantly lower than prior to HIV infection (diff = −6.16; 95% CI: [−8.09, −4.23]) after being on HAART for more than 4 years. The MHS did not significantly differ upon seroconversion (diff = −1.16; 95% CI: [−3.32, 1.00]). After using HAART for more than 4 years, the MHS was significantly greater than prior to HIV infection (diff = 2.93; 95% CI: [0.31, 5.55]) with a small effect size. Conclusion: The QOL of participants has been dynamic over the HIV disease course. HIV infection deteriorated physical but not mental QOL. In this group, although the PHS following HAART has remained lower than that prior to infection, HAART has enhanced mental health functioning.
Health-related quality of life and virologic outcomes in an HIV clinic
2000
Objective: The purpose of this study was to describe the relationship between viral load and health-related quality of life (HRQOL) in a cohort of persons with human immunode®ciency virus (HIV) infection. Design: We evaluated HRQOL measurements in a clinical cohort of HIV-positive patients recruited from a university-associated HIV primary care clinic. HRQOL instruments included the medical outcomes surveyshort form-36(MOS-SF-36) from which mental and physical component summary scores (MCS and PCS) and subscale scores were calculated. Results: Signi®cant negative associations were found between viral load and SF-36 PCS, physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), role-emotional (RE), and vitality (VT). Similar negative associations were found between CD4 cell count and SF-36 summary and subscale scores, with the notable exception of bodily pain. Multivariate analyses controlling for the eects of CD4 cell count and other clinical variables indicated viral load as an independent predictor of SF-36 PCS, RP, BP and VT scores. Conclusions: The relationship between viral load, a measure of HIV disease activity, and several dimensions of the SF-36, a patient-focused measure of HRQOL, appears to be strong and independent of CD4 cell count. These ®ndings suggest that having a lower viral load positively impacts the quality of life of HIV-positive patients.
International Journal of Pharmacy and Pharmaceutical Sciences, 2020
Methods: A cross-sectional study was conducted during February 2019 to January 2020 at Wangaya Hospital in Denpasar, Bali, Indonesia. QoL was assessed using the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L), EQ-5D index value, and the EuroQol visual analogue scale (EQ-VAS). The data was analyzed using Statistical Package for Social Science (SPSS) software package version 26.0. Bivariate analysis was tested using the cross-tabulation Gamma, Kruskal-Wallis and post hoc Mann-Whitney test. P value<0.05 was considered as statistically significant. Results: A total of 584 PLWHA took HAART for at least 3 mo. The median index value and EQ-VAS were 1.0 (range-0.514-1.0) and 100.00 (range 30-100), respectively. Most patients had problems in 'anxiety/depression' and 'pain/discomfort' domains. Predictors of better QoL included men, married, good adherence, and treatment duration>24 mo (p<0.05). Predictor of poorer QoL included an advanced HIV clinical stage(p=0.001). Conclusion: The QoL scores of PLWHA receiving HAART in our study were high; hence the QoL of PLWHA was good. The good QoL can be taken as the goal for HIV treatment in order to have a successful HAART therapy.
Quality of Life Research, 2007
This is the third study in a line of research which is designed to increase scientific understanding of the predictors of health-related quality of life (HRQOL) among men with HIV infection using data collected in large, prospective cohort study. Building on two prior investigations, this study examined the time-dependent relationships of psychosocial and clinical variables (active coping strategies, social support, CD4 cell count, comorbidity, and duration of HIV infection) and 10 HRQOL dimensions at two time points (baseline and 12 months). Using linear mixed models, we found that most relationships between the psychosocial and clinical variables and HRQOL dimensions were consistent across time. However, there were interactions between time and CD4 cell count and some HRQOL dimensions. Specifically, increased active coping and social support were positively related, whereas more comorbid conditions and longer HIV infection duration were negatively related with multiple HRQOL dimensions at both baseline and 12 months. CD4 cell count was positively associated with emotional well-being at both time points, but the associations between CD4 cell count and five HRQOL dimensions were negative at baseline but positive at 12 months. These findings provide additional support for the recommendation that clinicians and health planners should continually strive to enhance active coping strategies and social support, manage comorbid conditions, and incorporate duration of HIV diagnoses in their treatment plans. Because the relationships between CD4 cell count and HRQOL dimensions varied over time, it is important to recognize that results from laboratory tests (i.e., CD4 cell count) may have differential quality of life implications for patients at various times in their disease trajectories.
Antiviral therapy, 2004
To evaluate health-related quality of life (HRQoL) changes in patients treated with indinavir three-times daily after switching to a twice-daily indinavir/ritonavir regimen or continuing with the same regimen. Patients on HAART including indinavir three-times-daily with undetectable viral load were randomly assigned to continue with this therapy or to change to a twice-daily indinavir/ritonavir (800/100 mg) regimen. The Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire was used as the HRQoL measure. A total of 118 patients participated in the study, of which 59 (50%) were randomly assigned to continue with the three-times-daily regimen. Patients had a mean age of 39 years and 80% of them were male. At baseline, subjects included in the three-times-daily group presented a significantly greater number of symptoms than subjects in the twice-daily group, but no statistically significant differences were observed in MOS-HIV scores between the groups. In the intention-to-tr...
AIDS Research and Human Retroviruses, 2007
The health-related quality of life (HRQoL) outcomes in HIV-infected, treatment-naive patients starting different HAART regimens in a 3-year, randomised, multinational trial were compared. HRQoL was measured in a subgroup of patients enrolled in the INITIO study (153/911), using a modified version of the MOS-HIV questionnaire. The regimens compared in the INITIO trial were composed by two NRTIs (didanosine+stavudine) plus either a NNRTI (efavirenz) or a PI (nelfinavir), or both (efavirenz+nelfinavir). Primary HRQoL outcomes were Physical and Mental Health Summary scores (PHS and MHS, respectively). During follow up, an increase of PHS score was observed in all treatment arms. The MHS score remained substantially unchanged with the 4-drug combination and showed with both NNRTI-and PI-based 3-drug regimens a marked trend toward improvement, which became statistically significant when a multiple imputation method was used to adjust for missing data. Overall, starting all the combination regimens compared in the INITIO study was associated to a maintained or slightly improved HRQOL status, consistently with the positive immunological and virological changes observed in the main study. The observed differences in the MHS indicate a possible HRQoL benefit associated to the use of 3-drug, 2-class regimens and no additional benefit for the use of 4-drug, 3-class regimens, confirming that 3-drug, 2-class regimens which include 2NRTIs plus either a NNRTI or a PI should be preferred as initial treatment of HIV infection.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2014
Symptoms which are found to cluster consistently can have synergistic effects on patient outcomes and therefore may serve to predict morbidity or disentangle disease progression from comorbid conditions. Self-report HIV-specific symptom and HRQL measures were jointly analyzed in HIV-positive patients under different antiretroviral treatment regimens. The responses of [Formula: see text] patients from four countries to the 9-item Physical Health and Symptom dimension of the PROOQL-HIV questionnaire and an HIV Symptom checklist were analyzed. Item response modeling and multidimensional scaling were used to derive HRQL scores free of any differential item functioning related to gender and target language and to summarize symptom co-expression in patients under protease inhibitor treatment (PI, [Formula: see text], 45 %) versus other medication (Non-PI). Women reported poorer HRQL ([Formula: see text]), and HRQL did not differ between the target languages of French, English, and Thai. F...