, Volume 20, Issue 1, pp 21-27

The association of health-related quality of life with survival among persons with HIV infection in the united states

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Abstract

OBJECTIVES: Both clinical trials and observational studies of persons with HIV infection commonly include health-related quality of life (HRQOL) measures, but less is known about the relation of HRQOL to survival among persons with HIV since the development of effective antiretroviral treatment.

DESIGN/PARTICIPANTS: Prospective cohort study of a national probability sample of 2,864 adults receiving HIV care.

INDEPENDENT VARIABLES: The main independent variables were derived from the HIV Cost and Services Utilization Study (HCSUS) HRQOL measure, and include physical and mental HRQOL summary scores (divided into quartiles) constructed from the following items administered at baseline: physical functioning (9 items, α=0.91), role functioning (2 items, α=0.85), pain (2 items, α=0.84), general health perceptions (3 items, α=0.80), emotional well-being (7 items, α=0.90), social functioning (2 items, α=0.82), energy (2 items, α=0.74), and a single-item measure of disability days (days in bed for at least 0.5 day due to health).

MAIN OUTCOME VARIABLE: Death between January 1996 and December 1999.

ANALYSIS: Descriptive and multivariate adjusted Cox proportional hazards regression analysis of survival by physical and mental HRQOL.

RESULTS: By December 1999, 17% of the sample had died. In unadjusted analysis, persons in the higher quartiles of physical HRQOL, as well as those in the higher quartiles of mental HRQOL at baseline, had significantly better survival than those in lower quartiles. In multiple regressions controlling for a number of sociodemographic and clinical variables, the hazard of death for those in the highest quartile of physical HRQOL was one quarter of that for those in the lowest quartile. This difference was similar in magnitude to that observed for being on highly active antiretroviral therapy versus no antiretrovirals in this population. By contrast, there was no unique association of mental HRQOL with survival.

CONCLUSIONS: Physical HRQOL added prognostic information over and above the sociodemographic and routinely available clinical data such as CD4 count and stage of HIV infection. Measurement of HRQOL, which is often performed to identify problems or assess outcomes, is also useful prognostically.

The HIV Cost and Services Utilization Study was conducted under cooperative agreement U-01 HS08578 (M.F. Shapiro, Pl; S.A. Bozzette, Co-Pl) between RAND and the Agency for Health Research and Quality. Substantial additional funding for this cooperative agreement was provided by the Health Resources and Services Administration, the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institutes of Health Office of Research on Minority Health through the National Institute of Dental Research. Additional support was provided by Merck and Company Incorporated, Glaxo-Wellcome Incorporated, the National Institute on Aging, and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services. Dr. Hays was supported by a grant from the National Institute of Health (Al 28697). Drs. Cunningham and Hays also received partial support from the UCLA-Drew Project Export, National Institutes of Health, National Center on Minority Health and Health Disparities, (P20-MD00148-01), and the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, National Institutes of Health, National Institute of Aging (AG-02-004).