Quality of Life Research

, Volume 15, Issue 3, pp 503–514

Variations in Self-Rated Health Among Patients with HIV Infection

  • Joseph M. Mrus
  • Bruce R. Schackman
  • Albert W. Wu
  • Kenneth A. Freedberg
  • Joel Tsevat
  • Michael S. Yi
  • Robert Zackin


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.


AIDS Clinical trials HIV Quality of life 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tsevat, J 1994Methods for assessing health-related quality of␣life in HIV-infected patientsPsychol Health91930Google Scholar
  2. 2.
    Wu, AW, Hays, RD, Kelly, S, Malitz, F, Bozzette, SA 1997Applications of the Medical Outcomes Study health-related quality of life measures in HIV/AIDSQual Life Res6531554PubMedGoogle Scholar
  3. 3.
    Wilson, IB, Cleary, PD 1995Linking clinical variables with health-related quality of life. A conceptual model of patient outcomesJAMA2735965PubMedGoogle Scholar
  4. 4.
    Mossey, JM, Shapiro, E 1982Self-rated health: a predictor of mortality among the elderlyAm J Public Health72800808PubMedGoogle Scholar
  5. 5.
    Connelly, JE, Philbrick, JT, Smith, GR,Jr., Kaiser, DL, Wymer, A 1989Health perceptions of primary care patients and the influence on health care utilizationMed Care27S99S109PubMedGoogle Scholar
  6. 6.
    Wells, KB, Manning, WG, Duan, N, Newhouse, JP, Ware, JE 1986Sociodemographic factors and the use of outpatient mental health servicesMed Care247585PubMedGoogle Scholar
  7. 7.
    Idler, EL, Kasl, SV, Lemke, JH 1990Self-evaluated health and mortality among the elderly in New Haven, Connecticut, and Iowa and Washington counties, Iowa, 1982–1986Am J Epidemiol13191103PubMedGoogle Scholar
  8. 8.
    Idler, EL, Kasl, S 1991Health perceptions and survival: do global evaluations of health status really predict mortality?J Gerontol46S55S65PubMedGoogle Scholar
  9. 9.
    Idler, EL, Angel, RJ 1990Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up StudyAm J Public Health80446452PubMedGoogle Scholar
  10. 10.
    Desalvo, KB, Fan, VS, McDonell, MB, Fihn, SD 2005Predicting mortality and healthcare utilization with a single questionHealth Serv Res4012341246CrossRefPubMedGoogle Scholar
  11. 11.
    Call, SA, Klapow, JC, Stewart, KE,  et al. 2000Health-related quality of life and virologic outcomes in an HIV clinicQual Life Res9977985CrossRefPubMedGoogle Scholar
  12. 12.
    Miners, AH, Sabin, CA, Mocroft, A, Youle, M, Fisher, M, Johnson, M 2001Health-related quality of life in individuals infected with HIV in the era of HAARTHIV Clin Trials2484492CrossRefPubMedGoogle Scholar
  13. 13.
    Bing, EG, Hays, RD, Jacobson, LP,  et al. 2000Health-related quality of life among people with HIV disease: results from the Multicenter AIDS Cohort StudyQual Life Res95563CrossRefPubMedGoogle Scholar
  14. 14.
    Cunningham, WE, Bozzette, SA, Hays, RD, Kanouse, DE, Shapiro, MF 1995Comparison of health-related quality of life in clinical trial and nonclinical trial human immunodeficiency virus-infected cohortsMed Care33AS15AS25PubMedGoogle Scholar
  15. 15.
    Hays, RD, Cunningham, WE, Sherbourne, CD,  et al. 2000Health-related quality of life in patients with human immunodeficiency virus infection in the United States: results from the HIV Cost and Services Utilization StudyAm J Med108714722CrossRefPubMedGoogle Scholar
  16. 16.
    Lenderking, WR, Testa, MA, Katzenstein, D, Hammer, S 1997Measuring quality of life in early HIV disease: the modular approachQual Life Res6515530CrossRefPubMedGoogle Scholar
  17. 17.
    Murri, R, Fantoni, M, Del Borgo, C,  et al. 2003Determinants of health-related quality of life in HIV-infected patientsAIDS Care15581590CrossRefPubMedGoogle Scholar
  18. 18.
    Tsevat, J, Solzan, JG, Kuntz, KM,  et al. 1996Health values of patients infected with human immunodeficiency virus. Relationship to mental health and physical functioningMed Care344457CrossRefPubMedGoogle Scholar
  19. 19.
    Tsevat, J, Sherman, SN, McElwee, JA,  et al. 1999The will to live among HIV-infected patientsAnn Intern Med131194198PubMedGoogle Scholar
  20. 20.
    Mrus, JM, Williams, PL, Tsevat, J, Cohn, SE, Wu, AW 2005Gender differences in health-related quality of life in patients with HIV/AIDSQual Life Res14479491CrossRefPubMedGoogle Scholar
  21. 21.
    Paltiel, AD, Scharfstein, JA, Seage, GR.,III,  et al. 1998A Monte Carlo simulation of advanced HIV disease: application to prevention of CMV infectionMed Decis Making18S93S105PubMedGoogle Scholar
  22. 22.
    Freedberg, KA, Scharfstein, JA, Seage, GR,  et al. 1998The cost-effectiveness of preventing AIDS-related opportunistic infectionsJAMA279130136CrossRefPubMedGoogle Scholar
  23. 23.
    Goldie, SJ, Kaplan, JE, Losina, E,  et al. 2002Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia: using simulation modeling to inform clinical guidelinesArch Intern Med162921928CrossRefPubMedGoogle Scholar
  24. 24.
    Goldie, SJ, Kuntz, KM, Weinstein, MC, Freedberg, KA, Welton, ML, Palefsky, JM 1999The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive menJAMA28118221829CrossRefPubMedGoogle Scholar
  25. 25.
    Goldie, SJ, Weinstein, MC, Kuntz, KM, Freedberg, KA 1999The costs, clinical benefits, and cost-effectiveness of screening for cervical cancer in HIV-infected womenAnn Intern Med13097107PubMedGoogle Scholar
  26. 26.
    Freedberg, KA, Losina, E, Weinstein, MC,  et al. 2001The cost effectiveness of combination antiretroviral therapy for HIV diseaseN Engl J Med344824831CrossRefPubMedGoogle Scholar
  27. 27.
    Paltiel, AD, Goldie, SJ, Losina, E,  et al. 2001Pre evaluation of clinical trial data: the case of preemptive cytomegalovirus therapy in patients with human immunodeficiency virusClin Infect Dis32783793CrossRefPubMedGoogle Scholar
  28. 28.
    Weinstein, MC, Goldie, SJ, Losina, E,  et al. 2001Use of genotypic resistance testing to guide HIV therapy: clinical impact and cost-effectivenessAnn Intern Med134440450PubMedGoogle Scholar
  29. 29.
    Schackman, BR, Goldie, SJ, Weinstein, MC, Losina, E, Zhang, H, Freedberg, KA 2001Cost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adultsAm J Public Health9114561463PubMedGoogle Scholar
  30. 30.
    Johri, M, Paltiel, AD, Goldie, SJ, Freedberg, KA 2002State AIDS Drug Assistance Programs: equity and efficiency in an era of rapidly changing treatment standardsMed Care40429441CrossRefPubMedGoogle Scholar
  31. 31.
    HIV Cost and Services Utilization Study: public use data set. Rockville, MD: Agency for Healthcare Research and Quality, 2000.Google Scholar
  32. 32.
    Schackman, BR, Goldie, SJ, Freedberg, KA, Losina, E, Brazier, J, Weinstein, MC 2002Comparison of health state utilities using community and patient preference weights derived from a survey of patients with HIV/AIDSMed Decis Making222738CrossRefPubMedGoogle Scholar
  33. 33.
    Gifford, AL, Cunningham, WE, Heslin, KC,  et al. 2002Participation in research and access to experimental treatments by HIV-infected patientsN Engl J Med34613731382CrossRefPubMedGoogle Scholar
  34. 34.
    Hammer, SM, Squires, KE, Hughes, MD,  et al. 1997A 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 TeamN Engl J Med337725733CrossRefPubMedGoogle Scholar
  35. 35.
    Coplan, PM, Cook, JR, Carides, GW,  et al. 2004Impact of indinavir on the quality of life in patients with advanced HIV infection treated with zidovudine and lamivudineClin Infect Dis39426433CrossRefPubMedGoogle Scholar
  36. 36.
    Norman, GR, Sloan, JA, Wyrwich, KW 2003Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviationMed Care41582592PubMedGoogle Scholar
  37. 37.
    Hays, RD, Woolley, JM 2000The concept of clinically meaningful difference in healthrelated quality of life research. How meaningful is it?Pharmacoeconomics18419423CrossRefPubMedGoogle Scholar
  38. 38.
    Farivar, SS, Liu, H, Hays, RD 2004Half standard deviation estimate of the minimally important difference in HRQOL scores?Expert Rev Pharmacoeconomics Outcomes Res4515523CrossRefGoogle Scholar
  39. 39.
    Samsa, G, Edelman, D, Rothman, ML, Williams, GR, Lipscomb, J, Matchar, D 1999Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark IIPharmacoeconomics15141155CrossRefPubMedGoogle Scholar
  40. 40.
    Andersen, R, Bozzette, S, Shapiro, M,  et al. 2000Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization StudyHealth Serv Res35389416PubMedGoogle Scholar
  41. 41.
    Lorenz, KA, Shapiro, MF, Asch, SM, Bozzette, SA, Hays, RD 2001Associations of symptoms and health-related quality of life: findings from a national study of persons with HIV infectionAnn Intern Med134854860PubMedGoogle Scholar
  42. 42.
    Cykert, S, Joines, JD, Kissling, G, Hansen, CJ 1999Racial differences in patients’ perceptions of debilitated health statesJ Gen Intern Med14217222CrossRefPubMedGoogle Scholar
  43. 43.
    Owen, WF,Jr. 1996Racial differences in incidence, outcome, and quality of life for African-Americans on hemodialysisBlood Purif14278285PubMedGoogle Scholar
  44. 44.
    Tell, GS, Mittelmark, MB, Hylander, B, Shumaker, SA, Russell, G, Burkart, JM 1995Social support and health-related quality of life in black and white dialysis patientsANNA J22301308PubMedGoogle Scholar
  45. 45.
    Unruh, M, Miskulin, D, Yan, G,  et al. 2004Racial differences in health-related quality of life among hemodialysis patientsKidney Int6514821491CrossRefPubMedGoogle Scholar
  46. 46.
    Bozzette, SA, Berry, SH, Duan, N,  et al. 1998The care of HIV-infected adults in the United StatesN Engl J Med33918971904CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Joseph M. Mrus
    • 1
    • 2
    • 7
  • Bruce R. Schackman
    • 3
  • Albert W. Wu
    • 4
  • Kenneth A. Freedberg
    • 5
  • Joel Tsevat
    • 1
    • 2
  • Michael S. Yi
    • 2
  • Robert Zackin
    • 6
  1. 1.Health Services Research & DevelopmentCincinnati VA Medical CenterCincinnati
  2. 2.Department of Internal Medicine and Institute for the Study HealthUniversity of Cincinnati Medical CenterCincinnati
  3. 3.Department of Public HealthWeill Medical College of Cornell UniversityUSA
  4. 4.Departments of Health Policy and Management and MedicineThe Johns Hopkins UniversityBaltimore
  5. 5.Division of General Medicine and Partners AIDS Research CenterMassachusetts General Hospital, Harvard Medical SchoolBoston
  6. 6.Center for Biostatistics in AIDS ResearchHarvard School of Public HealthBostonUSA
  7. 7.Infectious Diseases Medicine Development CenterGlaxoSmithKlineUSA

Personalised recommendations