Determinants of health-related quality of life in HIV-infected patients

In the era of new antiretroviral treatments that have dramatically reduced both morbidity and mortality, a primary goal is to maximize function and wellbeing in the everyday life of HIV-infected patients. To be able to do so, it would be important for clinicians and policy makers to identify factors that influence health-related quality of life (HRQoL). The objective of this multicentre prospective cohort study was to identify determinants of HRQoL in a cohort of Italian HIV-infected patients, the majority of whom were taking highly active antiretroviral therapy (HAART). A total of 809 patients were enrolled. The MOS-HIV Health Survey (summarized using two scores, physical health (PHS) and mental health (MHS)), and an HIV-related symptom scale were administered at enrolment and six months later. At baseline, low CD4+ cell count, hospitalization during the three months before the enrollment and symptoms were independently related to poor PHS; hospitalization during the three months before the enrollment, symptoms and poor satisfaction with information from providers were independently related to MHS. Predictors of PHS at six months included the stage of HIV infection, baseline CD4+ cells count, PHS and symptom score; while age, baseline MHS, symptom score and education predicted six-month MHS. Among these factors, symptoms, recent hospitalization and satisfaction with information are most amenable to clinical intervention.

[1]  A. Wu,et al.  Quality of life outcomes of combination zidovudine–didanosine–nevirapine and zidovudine–didanosine for antiretroviral-naive advanced HIV-infected patients , 2000, AIDS.

[2]  Joel Tsevat,et al.  Predicting Functional Status Outcomes in Hospitalized Patients Aged 80 Years and Older , 2000, Journal of the American Geriatrics Society.

[3]  Rose Baker,et al.  Family Satisfaction with End‐of‐Life Care in Seriously Ill Hospitalized Adults , 2000, Journal of the American Geriatrics Society.

[4]  R. Willke,et al.  Relationship between CD4 count, viral burden, and quality of life over time in HIV-1-infected patients. , 2000, Medical care.

[5]  F. Parazzini,et al.  Incidence of Adverse Reactions in HIV Patients Treated With Protease Inhibitors: A Cohort Study , 2000, Journal of acquired immune deficiency syndromes.

[6]  F. Parazzini,et al.  Incidence of adverse reactions in HIV patients treated with protease inhibitors: a cohort study. Coordinamento Italiano Studio Allergia e Infezione da HIV (CISAI) Group. , 2000 .

[7]  K Henry,et al.  The Case for More Cautious, Patient-Focused Antiretroviral Therapy , 2000, Annals of Internal Medicine.

[8]  A. Wu,et al.  Quality of life in asymptomatic- and symptomatic HIV infected patients in a trial of ritonavir/saquinavir therapy , 2000, AIDS.

[9]  M A Fischl,et al.  Antiretroviral Therapy in Adults Updated Recommendations of the International AIDS Society–USA Panel , 2000 .

[10]  Richard Smith.  Medicine and the marginalised , 1999, BMJ.

[11]  A. Wu,et al.  Intravenous drug use, relationship with providers, and stage of HIV disease influence the prescription rates of protease inhibitors. , 1999, Journal of acquired immune deficiency syndromes.

[12]  L. Caplan,et al.  Factors That May Discourage Annual Mammography among Low-Income Women with Access to Free Mammograms: A Study Using Multi-Ethnic, Multiracial Focus Groups , 1999, Psychological reports.

[13]  K. Sepkowitz,et al.  The impact of potent antiretroviral therapy on the characteristics of hospitalized patients with HIV infection. , 1999, AIDS.

[14]  P. Kissinger,et al.  Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. , 1998, The New England journal of medicine.

[15]  G. Satten,et al.  Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. , 1998, The New England journal of medicine.

[16]  W. Dixon,et al.  Constitutional symptoms and health-related quality of life in patients with symptomatic HIV disease. , 1998, The American journal of medicine.

[17]  A. Wu,et al.  Reliability and validity of physical and mental health summary scores from the Medical Outcomes Study HIV Health Survey. , 1998, Medical care.

[18]  A. Antinori,et al.  Disease-related factors associated with health-related quality of life in people with nonadvanced HIV disease assessed using an Italian version of the MOS-HIV Health Survey. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[19]  S. Colleau,et al.  Underestimation and undertreatment of pain in HIV disease: multicentre study , 1997, BMJ.

[20]  I. Wilson,et al.  Clinical predictors of functioning in persons with acquired immunodeficiency syndrome. , 1996, Medical care.

[21]  H. Thaler,et al.  The undertreatment of pain in ambulatory AIDS patients , 1996, Pain.

[22]  Quality of life and clinical trials , 1995, The Lancet.

[23]  D. Kanouse,et al.  Comparison of health-related quality of life in clinical trial and nonclinical trial human immunodeficiency virus-infected cohorts. , 1995, Medical care.

[24]  C. Landefeld,et al.  An index of symptoms for infection with human immunodeficiency virus: reliability and validity. , 1994, Journal of clinical epidemiology.

[25]  A. Wu,et al.  Measuring health status and quality of life in HIV and AIDS , 1992 .

[26]  J. Fleishman,et al.  Quality of Life in Persons with Human Immunodeficiency Virus Infection: Measurement by the Medical Outcomes Study Instrument , 1992, Annals of Internal Medicine.

[27]  H. Rubin,et al.  A Health Status Questionnaire Using 30 Items From The Medical Outcomes Study: Preliminary Validation in Persons With Early HIV Infection , 1991, Medical care.

[28]  R. Deyo,et al.  Psychosocial predictors of disability in patients with low back pain. , 1988, The Journal of rheumatology.

[29]  E. Skinner,et al.  Functional outcomes following medical intensive care , 1986, Critical care medicine.

[30]  L. Tulman,et al.  The Impact of Personal Problems on Accessing Prenatal Care in Low-Income Urban African American Women , 1999, Journal of Perinatology.

[31]  M C Weinstein,et al.  Health values of patients infected with human immunodeficiency virus. Relationship to mental health and physical functioning. , 1996, Medical care.

[32]  William H. Rogers,et al.  Functional Status and Well-Being of Patients with Chronic Conditions , 1989 .