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.
References
Wenger, N., & Furberg, C. (1990). Cardiovascular disorders. Quality of life assessment in clinical trials (pp. 335–345). New York: Raven Press.
Emuren, L., Welles, S., Evans, A. A., Polansky, M., Okulicz, J. F., Macalino, G., et al. (2017). Health-related quality of life among military HIV patients on antiretroviral therapy. PLoS ONE,12(6), e0178953. https://doi.org/10.1371/journal.pone.0178953.
Liu, C., Ostrow, D., Detels, R., Hu, Z., Johnson, L., Kingsley, L., et al. (2006). Impacts of HIV infection and HAART use on quality of life. Quality of Life Research,15(6), 941–949. https://doi.org/10.1007/s11136-005-5913-x.
Jin, Y., Liu, Z., Wang, X., Liu, H., Ding, G., Su, Y., et al. (2014). A systematic review of cohort studies of the quality of life in HIV/AIDS patients after antiretroviral therapy. International Journal of STD and AIDS,25(11), 771–777. https://doi.org/10.1177/0956462414525769.
Rodriguez-Penney, A. T., Iudicello, J. E., Riggs, P. K., Doyle, K., Ellis, R. J., Letendre, S. L., et al. (2013). Co-morbidities in persons infected with HIV: Increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDS,27(1), 5–16. https://doi.org/10.1089/apc.2012.0329.
Nicholas, P. K., Kirksey, K. M., Corless, I. B., & Kemppainen, J. (2005). Lipodystrophy and quality of life in HIV: Symptom management issues. Applied Nursing Research,18(1), 55–58. https://doi.org/10.1016/j.apnr.2004.09.012.
Burgoyne, R. W., & Tan, D. H. (2008). Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART): A balancing act. Journal of Antimicrobial Chemotherapy,61(3), 469–473. https://doi.org/10.1093/jac/dkm499.
Protopopescu, C., Marcellin, F., Spire, B., Preau, M., Verdon, R., Peyramond, D., et al. (2007). Health-related quality of life in HIV-1-infected patients on HAART: a five-years longitudinal analysis accounting for dropout in the APROCO-COPILOTE cohort (ANRS CO-8). Quality of Life Research,16(4), 577–591. https://doi.org/10.1007/s11136-006-9151-7.
Fumaz, C. R., Tuldra, A., Ferrer, M. J., Paredes, R., Bonjoch, A., Jou, T., et al. (2002). Quality of life, emotional status, and adherence of HIV-1-infected patients treated with efavirenz versus protease inhibitor-containing regimens. Journal of Acquired Immune Deficiency Syndromes,29(3), 244–253.
Anis, A. H., Nosyk, B., Sun, H., Guh, D. P., Bansback, N., Li, X., et al. (2009). Quality of life of patients with advanced HIV/AIDS: measuring the impact of both AIDS-defining events and non-AIDS serious adverse events. Journal of Acquired Immune Deficiency Syndromes,51(5), 631–639. https://doi.org/10.1097/QAI.0b013e3181a4f00d.
Jia, H., Uphold, C. R., Zheng, Y., Wu, S., Chen, G. J., Findley, K., et al. (2007). A further investigation of health-related quality of life over time among men with HIV infection in the HAART era. Quality of Life Research,16(6), 961–968. https://doi.org/10.1007/s11136-007-9214-4.
Jia, H., Uphold, C. R., Wu, S., Chen, G. J., & Duncan, P. W. (2005). Predictors of changes in health-related quality of life among men with HIV infection in the HAART era. AIDS Patient Care STDS,19(6), 395–405. https://doi.org/10.1089/apc.2005.19.395.
Liu, C., Johnson, L., Ostrow, D., Silvestre, A., Visscher, B., & Jacobson, L. P. (2006). Predictors for lower quality of life in the HAART era among HIV-infected men. Journal of Acquired Immune Deficiency Syndromes,42(4), 470–477. https://doi.org/10.1097/01.qai.0000225730.79610.61.
Chun, H. M., Roediger, M. P., Hullsiek, K. H., Thio, C. L., Agan, B. K., Bradley, W. P., et al. (2012). Hepatitis B virus coinfection negatively impacts HIV outcomes in HIV seroconverters. Journal of Infectious Diseases,205(2), 185–193. https://doi.org/10.1093/infdis/jir720.
Chun, H. M., Fieberg, A. M., Hullsiek, K. H., Lifson, A. R., Crum-Cianflone, N. F., Weintrob, A. C., et al. (2010). Epidemiology of Hepatitis B virus infection in a US cohort of HIV-infected individuals during the past 20 years. Clinical Infectious Diseases,50(3), 426–436. https://doi.org/10.1086/649885.
Pelak, K., Goldstein, D. B., Walley, N. M., Fellay, J., Ge, D., Shianna, K. V., et al. (2010). Host determinants of HIV-1 control in African Americans. Journal of Infectious Diseases,201(8), 1141–1149. https://doi.org/10.1086/651382.
Spaulding, A. B., Lifson, A. R., Iverson, E. R., Ganesan, A., Landrum, M. L., Weintrob, A. C., et al. (2012). Gonorrhoea or chlamydia in a US military HIV-positive cohort. Sexually Transmitted Infections,88(4), 266–271. https://doi.org/10.1136/sextrans-2011-050173.
RAND. Scoring instructions for the 36-item short form survey (SF-36). Retrieved May 05, 2013, from https://www.rand.org/health/surveys_tools/mos/mos_core_36item_scoring.html.
Hays, R.D. SAS code for scoring 36-item health survey 1.0. Retrieved May 9, 2014, from https://gim.med.ucla.edu/FacultyPages/Hays/utils/SF36/sf36.sas.
Hopman, W. M., Berger, C., Joseph, L., Towheed, T., Prior, J. C., Anastassiades, T., et al. (2009). Health-related quality of life in Canadian adolescents and young adults: Normative data using the SF-36. Canadian Journal of Public Health,100(6), 449–452.
Fitzmaurice, G. M., Laird, N. M., & Ware, J. H. (2011). Applied longitudinal analysis (Second ed., Wiley Series in Probability and Statistics). New Jersey: Wiley.
Gakhar, H., Kamali, A., & Holodniy, M. (2013). Health-related quality of life assessment after antiretroviral therapy: a review of the literature. Drugs,73(7), 651–672. https://doi.org/10.1007/s40265-013-0040-4.
Degroote, S., Vogelaers, D., & Vandijck, D. M. (2014). What determines health-related quality of life among people living with HIV: an updated review of the literature. Archives of Public Health,72(1), 40. https://doi.org/10.1186/2049-3258-72-40.
Doyle, K., Weber, E., Atkinson, J. H., Grant, I., & Woods, S. P. (2012). Aging, prospective memory, and health-related quality of life in HIV infection. AIDS and Behavior,16(8), 2309–2318. https://doi.org/10.1007/s10461-011-0121-x.
Effros, R. B., Fletcher, C. V., Gebo, K., Halter, J. B., Hazzard, W. R., Horne, F. M., et al. (2008). Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clinical Infectious Diseases,47(4), 542–553. https://doi.org/10.1086/590150.
Corless, I. B., Kirksey, K. M., Kemppainen, J., Nicholas, P. K., McGibbon, C., Davis, S. M., et al. (2005). Lipodystrophy-associated symptoms and medication adherence in HIV/AIDS. AIDS Patient Care STDS,19(9), 577–586. https://doi.org/10.1089/apc.2005.19.577.
Potard, V., Chassany, O., Lavignon, M., Costagliola, D., & Spire, B. (2010). Better health-related quality of life after switching from a virologically effective regimen to a regimen containing efavirenz or nevirapine. AIDS Care,22(1), 54–61. https://doi.org/10.1080/09540120903033250.
Campo, R. E., Cohen, C., Grimm, K., Shangguan, T., Maa, J., & Seekins, D. (2010). Switch from protease inhibitor- to efavirenz-based antiretroviral therapy improves quality of life, treatment satisfaction and adherence with low rates of virological failure in virologically suppressed patients. International Journal of STD and AIDS,21(3), 166–171. https://doi.org/10.1258/ijsa.2009.008487.
Crum-Cianflone, N. F., Grandits, G., Echols, S., Ganesan, A., Landrum, M., Weintrob, A., et al. (2010). Trends and causes of hospitalizations among HIV-infected persons during the late HAART era: what is the impact of CD4 counts and HAART use? Journal of Acquired Immune Deficiency Syndromes,54(3), 248–257.
Pogany, K., van Valkengoed, I. G., Prins, J. M., Nieuwkerk, P. T., van der Ende, I., Kauffmann, R. H., et al. (2007). Effects of active treatment discontinuation in patients with a CD4+ T-cell nadir greater than 350 cells/mm3: 48-week Treatment Interruption in Early Starters Netherlands Study (TRIESTAN). Journal of Acquired Immune Deficiency Syndromes,44(4), 395–400. https://doi.org/10.1097/QAI.0b013e31802f83bc.
Joyce, V. R., Barnett, P. G., Chow, A., Bayoumi, A. M., Griffin, S. C., Sun, H., et al. (2012). Effect of treatment interruption and intensification of antiretroviral therapy on health-related quality of life in patients with advanced HIV: A randomized, controlled trial. Medical Decision Making,32(1), 70–82. https://doi.org/10.1177/0272989x10397615.
Burman, W. J., Grund, B., Roediger, M. P., Friedland, G., Darbyshire, J., & Wu, A. W. (2008). The impact of episodic CD4 cell count-guided antiretroviral therapy on quality of life. Journal of Acquired Immune Deficiency Syndromes,47(2), 185–193. https://doi.org/10.1097/QAI.0b013e31815acaa4.
Walker, A. M. (1996). Confounding by indication. Epidemiology,7(4), 335–336.
Panel on Antiretroviral Guidelines for Adults and Adolescents. (Updated February 2013. Accessed April 7, 2019). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. https://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
World Health Organization (WHO) (September 2015.). Guidelines on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Retrieved 7 April, 2019, from https://www.who.int/hiv/pub/guidelines/earlyreleasr-arv/en.
Rodger, A. J., & Sabin, C. A. (2016). How have guidelines on when to start antiretroviral therapy affected survival of people living with HIV infection? Current Opinion in HIV and AIDS,11(5), 487–491. https://doi.org/10.1097/coh.0000000000000307.
Eholié, S. P., Badje, A., Kouame, G. M., Ntakpe, J. B., Moh, R., Danel, C., et al. (2016). Antiretroviral treatment regardless of CD4 count: The universal answer to a contextual question. AIDS Research and Therapy,13, 27. https://doi.org/10.1186/s12981-016-0111-1.
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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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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DOI: https://doi.org/10.1007/s11136-020-02441-5