Abstract
Purpose:To assess how patients with HIV who are enrolled in a clinical trials cohort rate their health and to compare their ratings with those of patients with HIV from 2 other cohorts: the HIV Cost and Services Utilization Study (HCSUS), and Adult AIDS Clinical Trials Group protocol 320 (ACTG 320). Methods: We analyzed baseline information for the 1649 subjects enrolled in the Adult AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT) study prior to March 2002 who had self-rated health data available. We compared those results with results from 2 other groups: HCSUS, the only nationally representative sample of people in care for HIV in the U.S., which conducted baseline interviews in 1996 and 1997, and ACTG 320, a randomized, double-blinded, placebo-controlled trial comparing a 3-drug antiretroviral regimen with a 2-drug combination, which enrolled subjects in the same general time frame as HCSUS. We used t tests, Pearson correlations, and linear regression to determine factors associated with self-rated health and z scores to compare results between cohorts. Results: The mean (SD) rating scale value on a 0–100 scale for ALLRT participants was 79.8 (16.8). Values were significantly lower for subjects who were older, had a history of injection drug use, had lower CD4 cell counts, or were beginning salvage antiretroviral therapy. Subjects in ALLRT reported significantly better self-rated health at baseline than those in HCSUS or ACTG 320 (11–12% higher rating scale values in ALLRT; p<0.05). When cohort differences were accounted for through regression and stratification, the differences in scores between subjects in ALLRT and HCSUS increased and the differences in scores between subjects in ALLRT and ACTG 320 diminished. Conclusions: Self-rated health varied significantly by age, CD4 count, injection drug use history, and salvage therapy status. Differences in self-rated health for clinical trials and non-clinical trials samples appear to be substantial and should be considered when applying trial results to clinical populations.
Similar content being viewed by others
References
J Tsevat (1994) ArticleTitleMethods for assessing health-related quality of␣life in HIV-infected patients Psychol Health 9 19–30
AW Wu RD Hays S Kelly F Malitz SA Bozzette (1997) ArticleTitleApplications of the Medical Outcomes Study health-related quality of life measures in HIV/AIDS Qual Life Res 6 531–554 Occurrence Handle1:STN:280:ByiH2s7mtFY%3D Occurrence Handle9330553
IB Wilson PD Cleary (1995) ArticleTitleLinking clinical variables with health-related quality of life. A conceptual model of patient outcomes JAMA 273 59–65 Occurrence Handle1:STN:280:ByqD1cbhtlI%3D Occurrence Handle7996652
JM Mossey E Shapiro (1982) ArticleTitleSelf-rated health: a predictor of mortality among the elderly Am J Public Health 72 800–808 Occurrence Handle1:STN:280:Bi2B38fisVU%3D Occurrence Handle7091475
JE Connelly JT Philbrick GR Smith SuffixJr. DL Kaiser A Wymer (1989) ArticleTitleHealth perceptions of primary care patients and the influence on health care utilization Med Care 27 S99–S109 Occurrence Handle1:STN:280:BiaC2MfjtlA%3D Occurrence Handle2921890
KB Wells WG Manning N Duan JP Newhouse JE Ware (1986) ArticleTitleSociodemographic factors and the use of outpatient mental health services Med Care 24 75–85 Occurrence Handle1:STN:280:BimC3MjhtVU%3D Occurrence Handle3945131
EL Idler SV Kasl JH Lemke (1990) ArticleTitleSelf-evaluated health and mortality among the elderly in New Haven, Connecticut, and Iowa and Washington counties, Iowa, 1982–1986 Am J Epidemiol 131 91–103 Occurrence Handle1:STN:280:By%2BD1cnns1I%3D Occurrence Handle2293757
EL Idler S Kasl (1991) ArticleTitleHealth perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 46 S55–S65 Occurrence Handle1:STN:280:By6C2cjntVc%3D Occurrence Handle1997583
EL Idler RJ Angel (1990) ArticleTitleSelf-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study Am J Public Health 80 446–452 Occurrence Handle1:STN:280:By%2BC1Mnkt1U%3D Occurrence Handle2316767
KB Desalvo VS Fan MB McDonell SD Fihn (2005) ArticleTitlePredicting mortality and healthcare utilization with a single question Health Serv Res 40 1234–1246 Occurrence Handle10.1111/j.1475-6773.2005.00404.x Occurrence Handle16033502
SA Call JC Klapow KE Stewart et al. (2000) ArticleTitleHealth-related quality of life and virologic outcomes in an HIV clinic Qual Life Res 9 977–985 Occurrence Handle10.1023/A:1016668802328 Occurrence Handle1:STN:280:DC%2BD3M3ovVagtw%3D%3D Occurrence Handle11332226
AH Miners CA Sabin A Mocroft M Youle M Fisher M Johnson (2001) ArticleTitleHealth-related quality of life in individuals infected with HIV in the era of HAART HIV Clin Trials 2 484–492 Occurrence Handle10.1310/48ET-TT7G-35RA-D4C3 Occurrence Handle1:STN:280:DC%2BD3MjgtV2ruw%3D%3D Occurrence Handle11742437
EG Bing RD Hays LP Jacobson et al. (2000) ArticleTitleHealth-related quality of life among people with HIV disease: results from the Multicenter AIDS Cohort Study Qual Life Res 9 55–63 Occurrence Handle10.1023/A:1008919227665 Occurrence Handle1:STN:280:DC%2BD3cvlsFahtQ%3D%3D Occurrence Handle10981206
WE Cunningham SA Bozzette RD Hays DE Kanouse MF Shapiro (1995) ArticleTitleComparison of health-related quality of life in clinical trial and nonclinical trial human immunodeficiency virus-infected cohorts Med Care 33 AS15–AS25 Occurrence Handle1:STN:280:ByqB2c%2FhvVY%3D Occurrence Handle7723442
RD Hays WE Cunningham CD Sherbourne et al. (2000) ArticleTitleHealth-related quality of life in patients with human immunodeficiency virus infection in the United States: results from the HIV Cost and Services Utilization Study Am J Med 108 714–722 Occurrence Handle10.1016/S0002-9343(00)00387-9 Occurrence Handle1:STN:280:DC%2BD3cvhs1ektQ%3D%3D Occurrence Handle10924648
WR Lenderking MA Testa D Katzenstein S Hammer (1997) ArticleTitleMeasuring quality of life in early HIV disease: the modular approach Qual Life Res 6 515–530 Occurrence Handle10.1023/A:1018408115729 Occurrence Handle1:STN:280:ByiH2s7mtFU%3D Occurrence Handle9330552
R Murri M Fantoni C Del Borgo et al. (2003) ArticleTitleDeterminants of health-related quality of life in HIV-infected patients AIDS Care 15 581–590 Occurrence Handle10.1080/0954012031000134818 Occurrence Handle1:STN:280:DC%2BD3svkvFShtA%3D%3D Occurrence Handle14509872
J Tsevat JG Solzan KM Kuntz et al. (1996) ArticleTitleHealth values of patients infected with human immunodeficiency virus. Relationship to mental health and physical functioning Med Care 34 44–57 Occurrence Handle10.1097/00005650-199601000-00004 Occurrence Handle1:STN:280:BymC2c3jtV0%3D Occurrence Handle8551811
J Tsevat SN Sherman JA McElwee et al. (1999) ArticleTitleThe will to live among HIV-infected patients Ann Intern Med 131 194–198 Occurrence Handle1:STN:280:DyaK1Mzktlaisg%3D%3D Occurrence Handle10428736
JM Mrus PL Williams J Tsevat SE Cohn AW Wu (2005) ArticleTitleGender differences in health-related quality of life in patients with HIV/AIDS Qual Life Res 14 479–491 Occurrence Handle10.1007/s11136-004-4693-z Occurrence Handle15892437
AD Paltiel JA Scharfstein GR. Seage SuffixIII et al. (1998) ArticleTitleA Monte Carlo simulation of advanced HIV disease: application to prevention of CMV infection Med Decis Making 18 S93–S105 Occurrence Handle1:STN:280:DyaK1c3is1Whsw%3D%3D Occurrence Handle9566470
KA Freedberg JA Scharfstein GR Seage et al. (1998) ArticleTitleThe cost-effectiveness of preventing AIDS-related opportunistic infections JAMA 279 130–136 Occurrence Handle10.1001/jama.279.2.130 Occurrence Handle1:STN:280:DyaK1c7gtFKisQ%3D%3D Occurrence Handle9440663
SJ Goldie JE Kaplan E Losina et al. (2002) ArticleTitleProphylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelines Arch Intern Med 162 921–928 Occurrence Handle10.1001/archinte.162.8.921 Occurrence Handle1:CAS:528:DC%2BD38Xjs1eju7c%3D Occurrence Handle11966344
SJ Goldie KM Kuntz MC Weinstein KA Freedberg ML Welton JM Palefsky (1999) ArticleTitleThe clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men JAMA 281 1822–1829 Occurrence Handle10.1001/jama.281.19.1822 Occurrence Handle1:STN:280:DyaK1M3ntVWqtw%3D%3D Occurrence Handle10340370
SJ Goldie MC Weinstein KM Kuntz KA Freedberg (1999) ArticleTitleThe costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected women Ann Intern Med 130 97–107 Occurrence Handle1:STN:280:DyaK1M7ltVSjtA%3D%3D Occurrence Handle10068381
KA Freedberg E Losina MC Weinstein et al. (2001) ArticleTitleThe cost effectiveness of combination antiretroviral therapy for HIV disease N Engl J Med 344 824–831 Occurrence Handle10.1056/NEJM200103153441108 Occurrence Handle1:CAS:528:DC%2BD3MXisVGkt74%3D Occurrence Handle11248160
AD Paltiel SJ Goldie E Losina et al. (2001) ArticleTitlePre evaluation of clinical trial data: the case of preemptive cytomegalovirus therapy in patients with human immunodeficiency virus Clin Infect Dis 32 783–793 Occurrence Handle10.1086/319223 Occurrence Handle1:STN:280:DC%2BD3MvjsVGmsA%3D%3D Occurrence Handle11229847
MC Weinstein SJ Goldie E Losina et al. (2001) ArticleTitleUse of genotypic resistance testing to guide HIV therapy: clinical impact and cost-effectiveness Ann Intern Med 134 440–450 Occurrence Handle1:STN:280:DC%2BD3M7mt1Klsw%3D%3D Occurrence Handle11255519
BR Schackman SJ Goldie MC Weinstein E Losina H Zhang KA Freedberg (2001) ArticleTitleCost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults Am J Public Health 91 1456–1463 Occurrence Handle1:STN:280:DC%2BD3Mvpt1Srtg%3D%3D Occurrence Handle11527782
M Johri AD Paltiel SJ Goldie KA Freedberg (2002) ArticleTitleState AIDS Drug Assistance Programs: equity and efficiency in an era of rapidly changing treatment standards Med Care 40 429–441 Occurrence Handle10.1097/00005650-200205000-00008 Occurrence Handle11961477
HIV Cost and Services Utilization Study: public use data set. Rockville, MD: Agency for Healthcare Research and Quality, 2000.
BR Schackman SJ Goldie KA Freedberg E Losina J Brazier MC Weinstein (2002) ArticleTitleComparison of health state utilities using community and patient preference weights derived from a survey of patients with HIV/AIDS Med Decis Making 22 27–38 Occurrence Handle10.1177/02729890222062892 Occurrence Handle11833663
AL Gifford WE Cunningham KC Heslin et al. (2002) ArticleTitleParticipation in research and access to experimental treatments by HIV-infected patients N Engl J Med 346 1373–1382 Occurrence Handle10.1056/NEJMsa011565 Occurrence Handle11986412
SM Hammer KE Squires MD Hughes et al. (1997) ArticleTitleA controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team N Engl J Med 337 725–733 Occurrence Handle10.1056/NEJM199709113371101 Occurrence Handle1:CAS:528:DyaK2sXmt1yit7o%3D Occurrence Handle9287227
PM Coplan JR Cook GW Carides et al. (2004) ArticleTitleImpact of indinavir on the quality of life in patients with advanced HIV infection treated with zidovudine and lamivudine Clin Infect Dis 39 426–433 Occurrence Handle10.1086/422520 Occurrence Handle1:CAS:528:DC%2BD2cXnsFSmtLg%3D Occurrence Handle15307012
GR Norman JA Sloan KW Wyrwich (2003) ArticleTitleInterpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation Med Care 41 582–592 Occurrence Handle12719681
RD Hays JM Woolley (2000) ArticleTitleThe concept of clinically meaningful difference in healthrelated quality of life research. How meaningful is it? Pharmacoeconomics 18 419–423 Occurrence Handle10.2165/00019053-200018050-00001 Occurrence Handle1:STN:280:DC%2BD3M%2FpvVWktg%3D%3D Occurrence Handle11151395
SS Farivar H Liu RD Hays (2004) ArticleTitleHalf standard deviation estimate of the minimally important difference in HRQOL scores? Expert Rev Pharmacoeconomics Outcomes Res 4 515–523 Occurrence Handle10.1586/14737167.4.5.515
G Samsa D Edelman ML Rothman GR Williams J Lipscomb D Matchar (1999) ArticleTitleDetermining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II Pharmacoeconomics 15 141–155 Occurrence Handle10.2165/00019053-199915020-00003 Occurrence Handle1:STN:280:DyaK1M3isFyitg%3D%3D Occurrence Handle10351188
R Andersen S Bozzette M Shapiro et al. (2000) ArticleTitleAccess of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study Health Serv Res 35 389–416 Occurrence Handle1:STN:280:DC%2BD3czhtlKjtw%3D%3D Occurrence Handle10857469
KA Lorenz MF Shapiro SM Asch SA Bozzette RD Hays (2001) ArticleTitleAssociations of symptoms and health-related quality of life: findings from a national study of persons with HIV infection Ann Intern Med 134 854–860 Occurrence Handle1:STN:280:DC%2BD3M3lsFWnsg%3D%3D Occurrence Handle11346321
S Cykert JD Joines G Kissling CJ Hansen (1999) ArticleTitleRacial differences in patients’ perceptions of debilitated health states J Gen Intern Med 14 217–222 Occurrence Handle10.1046/j.1525-1497.1999.00320.x Occurrence Handle1:STN:280:DyaK1M3itFyiug%3D%3D Occurrence Handle10203633
WF Owen SuffixJr. (1996) ArticleTitleRacial differences in incidence, outcome, and quality of life for African-Americans on hemodialysis Blood Purif 14 278–285 Occurrence Handle8873953
GS Tell MB Mittelmark B Hylander SA Shumaker G Russell JM Burkart (1995) ArticleTitleSocial support and health-related quality of life in black and white dialysis patients ANNA J 22 301–308 Occurrence Handle1:STN:280:ByqA3crmtlA%3D Occurrence Handle7786078
M Unruh D Miskulin G Yan et al. (2004) ArticleTitleRacial differences in health-related quality of life among hemodialysis patients Kidney Int 65 1482–1491 Occurrence Handle10.1111/j.1523-1755.2004.00529.x Occurrence Handle15086492
SA Bozzette SH Berry N Duan et al. (1998) ArticleTitleThe care of HIV-infected adults in the United States N Engl J Med 339 1897–1904 Occurrence Handle10.1056/NEJM199812243392606 Occurrence Handle1:STN:280:DyaK1M%2FmslWmtw%3D%3D Occurrence Handle9862946
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mrus, J.M., Schackman, B.R., Wu, A.W. et al. Variations in Self-Rated Health Among Patients with HIV Infection. Qual Life Res 15, 503–514 (2006). https://doi.org/10.1007/s11136-005-1946-4
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11136-005-1946-4