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Health-Related Quality of Life Dynamics of HIV-positive South African Women up to ART Initiation: Evidence from the CAPRISA 002 Acute Infection Cohort Study

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Abstract

Few studies have investigated the long-term dynamics in health-related quality of life (HRQoL) among HIV-positive persons from acute infection. From 2004, 160 women were enrolled into the CAPRISA 002 Acute Infection study at two sites in the province of KwaZulu-Natal and underwent 3–6 monthly HRQoL assessments using the functional assessment of HIV infection (FAHI) instrument. Overall and 5 sub-scale FAHI scores [physical well-being (PWB), emotional well-being (EWB), functional and global well-being (FGWB), social well-being (SWB) and cognitive functioning (CF)] were calculated up to antiretroviral therapy (ART) initiation and scores at enrollment were compared to the acute, early and established infection phases. Mixed-effects regression models adjusting for behavioral and clinical factors were applied to assess HRQoL trends and the proportion of women meeting minimally important differences was calculated. Our analyses revealed that overall/sub-scale scores improved over time, except from PWB and CF. A higher educational status, contraceptive use and a higher BMI were the strongest predictors of higher overall/sub-scale FAHI scores. CD4 count and HIV viral load were strongly associated with PWB and CF, but not overall FAHI and other sub-scales. Women newly diagnosed with acute HIV infection face profound HRQoL challenges. While early ART delivery may be important for PWB and CF, factors such as education, contraception provision and good nutritional status should be promoted to maximize HRQoL in HIV positive individuals.

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Acknowledgments

We thank all the CAPRISA 002 acute infection study participants who are making an important personal contribution to HIV research through their continued support and participation in our work. The scientific and supportive role of the whole CAPRISA 002 study and protocol team is gratefully acknowledged. Preliminary data from this article was presented at the South African AIDS Conference in Durban, South Africa on June 19th 2013. The first author was supported by the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental & Craniofacial Research, National Institute on Drug Abuse, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases Health, and NIH Office of Women’s Health and Research through the International Clinical Research Fellows Program at Vanderbilt University (R24 TW007988) and the American Recovery and Reinvestment Act. Centre for the AIDS Programme of Research in South Africa (CAPRISA) received support for the CAPRISA 002 Acute Infection Study from the Comprehensive International Program of Research on AIDS (CIPRA) funded by the National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health (NIH) and the US Department of Health and Human Services (1 U19 AI51794).

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Authors and Affiliations

  1. Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa

    Andrew Tomita, Nigel Garrett, Lise Werner, Lindiwe Mpanza, Koleka Mlisana & Salim S. Abdool Karim

  2. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

    Andrew Tomita, Nigel Garrett, Lise Werner, Jonathan K. Burns, Koleka Mlisana & Salim S. Abdool Karim

  3. Columbia University Mailman School of Public Health, New York, NY, USA

    Andrew Tomita & Salim S. Abdool Karim

  4. Medical Microbiology Department, National Health Laboratory Service, Durban, South Africa

    Koleka Mlisana

  5. The Global Health Network, Centre for Tropical Medicine, University of Oxford, Oxford, UK

    Francois van Loggerenberg

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  1. Andrew Tomita
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  2. Nigel Garrett
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  8. Salim S. Abdool Karim
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Correspondence to Andrew Tomita.

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Tomita, A., Garrett, N., Werner, L. et al. Health-Related Quality of Life Dynamics of HIV-positive South African Women up to ART Initiation: Evidence from the CAPRISA 002 Acute Infection Cohort Study. AIDS Behav 18, 1114–1123 (2014). https://doi.org/10.1007/s10461-013-0682-y

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