Advertisement

Quality of Life Research

, Volume 25, Issue 12, pp 3067–3076 | Cite as

Longitudinal assessment of health related quality of life of HIV infected patients treated for tuberculosis and HIV in a high burden setting

  • Thuli Mthiyane
  • Alex Pym
  • Keertan Dheda
  • Roxana Rustomjee
  • T. Reddy
  • Shamila Manie
Article

Abstract

Introduction

Assessment of patients receiving treatment for human immunodeficiency virus (HIV) and tuberculosis (TB) using a Health Related Quality of Life (HRQoL) instrument is important to get the subjective view of the patients’ wellbeing.

Methods

We used the Functional Assessment of HIV Infection (FAHI) HRQoL instrument to collect perceived wellness information at baseline, month 3, 6 and 12 from patients enrolled in a pharmacokinetic study between March 2007 and April 2008. Composite domain scores at each time point and their relationship with the rate of adverse events (AEs) and serious adverse events were compared between treatment arms.

Results

Out of the 82 patients enrolled, 76 were analysed. There was a significant increase in total score in all groups between baseline, month 3, 6 and 12 (all p values < 0.0001), and over time (p < 0.001). Adjusting for baseline total score, baseline CD4 count had a significant effect on the total score over time (p = 0.002) and the rate of change in total score over time, that is; interaction effect (p < 0.001). There was no difference in each domain scores between participants that received ART with TB treatment and those that received TB treatment only. Respiratory AEs had a significant effect on HRQoL.

Conclusion

We found that assessment of HRQoL of participants in TB–HIV treatment using the FAHI instrument was useful in evaluating treatment responses. It showed improvement consistent with decrease in adverse events and signs and symptoms of TB. Number and type of AEs was related to lower HRQoL in spite of TB cure.

Keywords

Health Related Quality of Life Tuberculosis HIV Adverse events 

Notes

Acknowledgments

The study was sponsored by the Special Programme for Research and Training in Tropical Diseases, World Health Organization and United States Agency for International Development (USAID, Umbrella Grant no. AAG-G-00-99-00005). The European & Developing Countries Clinical Trials Partnership (EDCTP) supplied supplementary funding of the PhD (training grant). The Medical Research Council of South Africa (SAMRC) provided additional finances for the study. We also acknowledge the generous donations of antiretroviral drugs from two major pharmaceutical companies, GlaxoSmithKline (UK) and Merck (USA), without which the study would not have been conducted. These sponsors had nothing to do with study conduct. We would also like to thank the study staff for their hard work and patients for their involvement in this study.

Author contributions

TM participated in design, managed the study and drafted the manuscript. RR, KD and AP participated in the design and management of the study, TR performed the statistical analysis, SM helped draft the manuscript and assisted with its final edit. All authors read and approved the manuscript.

Compliance with ethical standards

Conflict of interest

There were no competing interests declared by any of the authors.

Ethical approval

The study was approved by the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (KZN), reference numbers E294/05 and BFC 037/08. All procedures performed in the study were in accordance with ethical standards of the national and institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Lorenz, K., et al. (2006). Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV. Quality of Life Research, 15(6), 951–958.CrossRefPubMedGoogle Scholar
  2. 2.
    Kaplan, R. M., & Bush, J. W. (1982). Health-related quality of life measurement for evaluation research and policy analysis. Health Psychology, 1(1), 61.CrossRefGoogle Scholar
  3. 3.
    Aggarwal, A. N., et al. (2013). Assessment of health-related quality of life in patients with pulmonary tuberculosis under programme conditions. The International Journal of Tuberculosis and Lung Disease, 17(7), 947–953.CrossRefPubMedGoogle Scholar
  4. 4.
    Mekasha, T. & Woldemichael, K. (2009). Assessment of patients’ health related quality of life during tuberculosis treatment as compared to their neighbours in Hawassa town, Ethiopia. Master’s thesis in public health.Google Scholar
  5. 5.
    Marra, C., et al. (2004). Factors influencing quality of life in patients with active tuberculosis. Health and Quality of Life Outcomes, 2, 58.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Duyan, B., et al. (2005). Relationship between quality of life and characteristics of patients hospitalized with tuberculosis. The International Journal of Tuberculosis and Lung Disease, 9(12), 1361–1366.PubMedGoogle Scholar
  7. 7.
    Hansel, N., et al. (2004). Quality of life in tuberculosis: Patient and provider perspectives. Quality of Life Research, 13, 639–652.CrossRefPubMedGoogle Scholar
  8. 8.
    Guo, N., Marra, F., & Marra, C. (2009). Measuring health-related quality of life in tuberculosis: A systematic review. Health and Quality of Life Outcomes, 7(1), 14.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dhuria, M., Sharma, N., & Ingle, G. (2008). Impact of tuberculosis on the quality of life. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 33(1), 58.CrossRefGoogle Scholar
  10. 10.
    Kohli, R. M., et al. (2005). Assessment of quality of life among HIV-infected persons in Pune, India. Quality of life Research, 14(6), 1641–1647.CrossRefPubMedGoogle Scholar
  11. 11.
    Mutimura, E., Stewart, A., & Crowther, N. (2007). Assessment of quality of life in HAART-treated HIV-positive subjects with body fat redistribution in Rwanda. AIDS Research and Therapy, 4(19), 1–8.Google Scholar
  12. 12.
    Murri, R., et al. (2003). Determinants of health-related quality of life in HIV-infected patients. AIDS Care, 15, 581–590.CrossRefPubMedGoogle Scholar
  13. 13.
    Campsmith, M. L., Nakashima, A. K., & Davidson, A. J. (2003). Self-reported health-related quality of life in persons with HIV infection: Results from a multi-site interview project. Health Quality Life Outcomes, 1, 12.CrossRefGoogle Scholar
  14. 14.
    Gill, C. J., et al. (2002). Relationship of HIV viral loads, CD4 counts, and HAART use to health-related quality of life. Journal of acquired immune deficiency syndromes (1999), 30(5), 485–492.CrossRefGoogle Scholar
  15. 15.
    McInerney, P. (2008). Quality of life and physical functioning in HIV-infected individuals receiving antiretroviral therapy in KwaZulu-Natal, South Africa. Nursing & Health Sciences, 10(4), 266–272.CrossRefGoogle Scholar
  16. 16.
    O’Keefe, E., & Wood, R. (1996). The impact of human immunodeficiency virus (HIV) infection on quality of life in a multiracial South African population. Quality of Life Research, 5(2), 275–280.CrossRefPubMedGoogle Scholar
  17. 17.
    Robberstad, B., & Olsen, J. (2010). The health related quality of life of people living with HIV/AIDS in sub-Saharan Africa—A literature review and focus group study. Cost Effectiveness and Resource Allocation, 8(1), 5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Deribew, A., et al. (2013). Change in quality of life: A follow up study among patients with HIV infection with and without TB in Ethiopia. BMC Public Health, 13(1), 408.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Louw, J., et al. (2012). Quality of life among tuberculosis (TB), TB retreatment and/or TB–HIV co-infected primary public health care patients in three districts in South Africa. Health Quality Life Outcomes, 10(77), 1477–7525.Google Scholar
  20. 20.
    Dowdy, D. W., et al. (2013). Quality of life among people treated for tuberculosis and human immunodeficiency virus in Rio de Janeiro, Brazil. The International Journal of Tuberculosis and Lung Disease, 17(3), 345–347.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    World Health Organization. (2013). Global tuberculosis report 2013. Geneva, Switzerland: WHO, HTM/TB.Google Scholar
  22. 22.
    WHO. (2014). Global Tuberculosis Report 2014. World Health Organization.Google Scholar
  23. 23.
    Bekker, L.-G., & Wood, R. (2010). The changing natural history of tuberculosis and HIV coinfection in an urban area of hyperendemicity. Clinical Infectious Diseases, 50(Supplement 3), S208–S214.CrossRefPubMedGoogle Scholar
  24. 24.
    Godfrey-Faussett, P., et al. (2002). How human immunodeficiency virus voluntary testing can contribute to tuberculosis control. Bulletin of the World Health Organization, 80(12), 939–945.PubMedGoogle Scholar
  25. 25.
    Lawn, S. D., Torok, M. E., & Wood, R. (2011). Optimum time to start antiretroviral therapy during HIV-associated opportunistic infections. Current Opinion in Infectious Diseases, 24(1), 34–42.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Badri, M., Wilson, D., & Wood, R. (2002). Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: A cohort study. Lancet, 359, 2059–2064.CrossRefPubMedGoogle Scholar
  27. 27.
    Yee, D., et al. (2003). American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of tuberculosis Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. American Journal of Respiratory and Critical Care Medicine, 167, 603–662.CrossRefGoogle Scholar
  28. 28.
    McIlleron, H., et al. (2012). Reduced antituberculosis drug concentrations in HIV-infected patients who are men or have low weight: Implications for international dosing guidelines. Antimicrobial Agents and Chemotherapy, 56(6), 3232–3238.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Cella, D. F., et al. (1996). Development and validation of the functional assessment of human immunodeficiency virus infection (FAHI) quality of life instrument. Quality of Life Research, 5(4), 450–463.CrossRefPubMedGoogle Scholar
  30. 30.
    Verbeke, G., & Molenberghs, G. (2009). Linear mixed models for longitudinal data. New YorK: Springer.Google Scholar
  31. 31.
    Viala-Danten, M., et al. (2010). Psychometric evaluation of the functional assessment of HIV Infection (FAHI) questionnaire and its usefulness in clinical trials. Quality of Life Research, 19(8), 1215–1227.CrossRefPubMedGoogle Scholar
  32. 32.
    Wu, A. W., et al. (2004). Changes in quality of life during hemodialysis and peritoneal dialysis treatment: Generic and disease specific measures. Journal of the American Society of Nephrology, 15(3), 743–753.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee, S. W., et al. (2006). The prevalence and evolution of anemia associated with tuberculosis. Journal of Korean Medical Science, 21(6), 1028–1032.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Call, S., et al. (2000). Health-related quality of life and virologic outcomes in an HIV clinic. Quality of Life Research, 9(9), 977–985.CrossRefPubMedGoogle Scholar
  35. 35.
    Timilsina, S., & Regmi, K. (2015). Assessing quality of life and depression among people living with HIV/AIDS and TB–HIV coinfection in Kathmandu, Nepal. SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, 11(2), 7–14.CrossRefGoogle Scholar
  36. 36.
    Akinboro, A.O., et al. (2014). Quality of life of Nigerians living with human immunodeficiency virus. The Pan African Medical Journal, 18, 234.Google Scholar
  37. 37.
    Deribew, A., et al. (2013). Change in quality of life: A follow up study among patients with HIV infection with and without TB in Ethiopia. BMC Public Health, 13(408), 1471–2458.Google Scholar
  38. 38.
    Venter, E., Gericke, G., & Bekker, P. (2009). Nutritional status, quality of life and CD4 cell count of adults living with HIV/AIDS in the Ga-Rankuwa area (South Africa): Original research. South African Journal of Clinical Nutrition, 3, 124–129.CrossRefGoogle Scholar
  39. 39.
    Bauer, M., Leavens, A., & Schwartzman, K. (2013). A systematic review and meta-analysis of the impact of tuberculosis on health-related quality of life. Quality of Life Research, 22(8), 2213–2235.CrossRefPubMedGoogle Scholar
  40. 40.
    Ralph, A. P., et al. (2013). High morbidity during treatment and residual pulmonary disability in pulmonary tuberculosis: Under-recognised phenomena. PLoS One, 8(11), e80302.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Cella, D., Hahn, E., & Dineen, K. (2002). Meaningful change in cancer-specific quality of life scores: Differences between improvement and worsening. Quality of Life Research, 11(3), 207–221.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.South African Medical Research CouncilDurbanSouth Africa
  2. 2.Biostatistics UnitSouth African Medical Research CouncilDurbanSouth Africa
  3. 3.Division of Pulmonology, Department of MedicineUniversity of Cape TownCape TownSouth Africa
  4. 4.KZN Research Institute for Tuberculosis and HIVDurbanSouth Africa
  5. 5.Division of Physiotherapy, Department of Health and Rehabilitation SciencesUniversity of Cape TownCape TownSouth Africa

Personalised recommendations