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Predictors of health-related quality of life among military HIV-infected individuals

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Abstract

Objectives

To determine long-term predictors of health-related quality of life (HRQOL) and evaluate the treatment effect of highly active antiretroviral therapy (HAART) on HRQOL in the US Military HIV Natural History Study (NHS) cohort.

Methods

Participants were a nested cohort of the NHS who responded to the Rand Short Form 36 questionnaire administered from 2006 to 2010. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed using standard algorithms. HAART-status was categorized as non-protease inhibitor-based (NPI-HAART), protease inhibitor-based (PI-HAART), HAART-naïve, or off-HAART. Mixed linear random effects models were used to estimate changes in PCS and MCS over time for treatment and covariates (including CD4 count, HIV viral load, medical and mental comorbidities).

Results

Eight hundred and twelve participants met the inclusion criteria. There was no difference in PCS or MCS between those on PI-HAART compared to NPI-HAART. Significant predictors of PCS were CD4 count < 200 cells/mm3 (β = − 2.90), CD4 count 200–499 cells/mm3 (β = − 0.80), and mental comorbidity (β = − 3.23). Others were medical comorbidity, AIDS-defining illness, being on NPI-HAART, HAART-naïve, age, and rank. Those with medical comorbidities experienced yearly improvement in PCS. Predictors of MCS were CD4 count < 200 cells/mm3 (β = − 2.53), mental comorbidity (β = − 4.58), and being African American (β = 2.59).

Conclusion

HRQOL was significantly affected by low CD4 count, medical and mental comorbidities. Addressing these modifiable factors would be expected to improve the physical and mental HRQOL of the cohort. Our study did not find any treatment benefit of NPI-HAART over PI-HAART on HRQOL in the long term.

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Data availability

Data for this study are available from the Infectious Disease Clinical Research Program (IDCRP), headquartered at the Uniformed Services University of the Health Sciences (USU), Department of Preventive Medicine and Biostatistics. The Informed Consent Document under which the HIV Natural History Study data were collected specifies that each use of the data will be reviewed by the Institutional Review Board. Furthermore, the data set may include Military Health System data collected under a Data Assurance Agreement that requires accounting for uses of the data. Data requests may be sent to: Address: 11,300 Rockville Pike, Suite 600, Rockville, MD 20,852; Email: contactus@idcrp.org.

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Acknowledgements

This study was conducted by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed by the Uniformed Services University of the Health Sciences (USUHS) through a cooperative agreement with The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF). This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter‐Agency Agreement Y1-AI-5072. We thank the members of the Infectious Disease Clinical Research Program HIV Working Group for collecting and reviewing study data and ensuring effective protocol operations: Brooke Army Medical Center, Fort Sam Houston, TX: S. De Leon; S. Merritt; T. Merritt; Lt Col J. Okulicz; T. Sjoberg. Madigan Army Medical Center, Joint Base Lewis McChord, WA: C. Baker; S. Chambers; R. Colombo; COL T. Ferguson; LTC A. Kunz; C. Schofield; M. Stein. National Institute of Allergy and Infectious Diseases, Bethesda, MD: J. Powers; COL (Ret.) E. Tramont. Naval Medical Center Portsmouth, Portsmouth, VA: S. Banks; CAPT K. Kronmann; T. Lalani; R. Tant; T. Warkentien. Naval Medical Center San Diego, San Diego, CA: S. Cammarata; N. Kirkland; CAPT R. Maves; CAPT (Ret.) G. Utz. Tripler Army Medical Center, Honolulu, HI: COL M. Price. Uniformed Services University of the Health Sciences, Bethesda, MD: B. Agan; X. Chu; C. Estupigan; W. Horton; H. Hsieh; A. Noiman; E. Parmelee; D. Tribble; X. Wang; S. Won. Walter Reed Army Institute of Research, Silver Spring, MD: T. Crowell; S. Peel. Walter Reed National Military Medical Center, Bethesda, MD: I. Barahona; LTC J. Blaylock; C. Decker; A. Ganesan; COL R. Ressner; D. Wallace.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Leonard Emuren, Seth Welles, Alison A. Evans & Marcia Polansky

  2. Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA

    Leonard Emuren

  3. Children’s Hospital of the King’s Daughters, 601 Children’s Lane, Norfolk, VA, USA

    Leonard Emuren

  4. Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Grace Macalino, Anuradha Ganesan, Rhonda E. Colombo & Brian K. Agan

  5. The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA

    Grace Macalino, Anuradha Ganesan, Rhonda E. Colombo & Brian K. Agan

  6. Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Anuradha Ganesan

  7. Division of Infectious Diseases, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA

    Rhonda E. Colombo

Authors
  1. Leonard Emuren
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  2. Seth Welles
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  3. Grace Macalino
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  4. Alison A. Evans
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  5. Marcia Polansky
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  6. Anuradha Ganesan
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  7. Rhonda E. Colombo
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  8. Brian K. Agan
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Consortia

the Infectious Disease Clinical Research Program HIV Working Group

  • S. De Leon
  • , S. Merritt
  • , T. Merritt
  • , J. Okulicz
  • , T. Sjoberg
  • , C. Baker
  • , S. Chambers
  • , R. Colombo
  • , T. Ferguson
  • , A. Kunz
  • , C. Schofield
  • , M. Stein
  • , J. Powers
  • , E. Tramont
  • , S. Banks
  • , K. Kronmann
  • , T. Lalani
  • , R. Tant
  • , T. Warkentien
  • , S. Cammarata
  • , N. Kirkland
  • , R. Maves
  • , G. Utz
  • , M. Price
  • , B. Agan
  • , X. Chu
  • , C. Estupigan
  • , W. Horton
  • , H. Hsieh
  • , A. Noiman
  • , E. Parmelee
  • , D. Tribble
  • , X. Wang
  • , S. Won
  • , T. Crowell
  • , S. Peel
  • , I. Barahona
  • , J. Blaylock
  • , C. Decker
  • , A. Ganesan
  • , R. Ressner
  •  & D. Wallace

Contributions

All authors contributed to the content of the manuscript and concurred with the decision to submit it for publication.

Corresponding author

Correspondence to Brian K. Agan.

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All of the authors declare no competing interests or financial interest in this work.

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The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of Uniformed Services University of the Health Sciences (USUHS), The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), the Department of Defense (DoD), the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The investigators have adhered to the policies for protection of human subjects as prescribed in 45CFR46.

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Emuren, L., Welles, S., Macalino, G. et al. Predictors of health-related quality of life among military HIV-infected individuals. Qual Life Res 29, 1855–1869 (2020). https://doi.org/10.1007/s11136-020-02441-5

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