Abstract
Aim: Zidovudine and tenofovir form the backbone of antiretroviral therapy in Kenya. However, their side-effects may affect the quality of life (QoL) of patients. The aim was to compare the health-related quality of life (HRQoL) of adult patients on tenofovir versus zidovudine based regimens in a referral hospital in Kenya to provide future guidance.Methods: A comparative cross sectional study among 501 adult out-patients on either tenofovir or zidovudine was undertaken in Kenyatta National Hospital between 2015 and 2016. The Medical Outcome Study HIV Health Survey (MOS-HIV) was administered along with other key aspects of treatment. Linear regression analysis was performed to identify determinants of HRQoL.Results: Patients on zidovudine had a higher Physical Health Summary Score (PHSS) and Mental Health Summary Score (MHSS) compared to those on tenofovir. The presence of any symptom of the disease and a stated inability to cope were negatively associated with PHSS, whilst having a regular source of income improved PHSS. Being on tenofovir, symptom of illness [β = -1.24; 95% CI (-2.253, -0.226)], absence of pain [β=0.413; 95% CI (0.152, 0.674)] and patient stated inability to cope with HIV [β = -1.029; 95% CI (-1.441, -0.617)] affected the MHSS. Patients on tenofovir and second line regimens had more signs and symptoms of illness.Conclusion: Participants on zidovudine based regimens showed a better performance across all aspects of HRQoL. These are considerations for the future.
Highlights
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO Constitution of The World Health Organization, 2006)
Symptom of illness [β = −1.24; 95% CI (−2.253, −0.226)], absence of pain [β=0.413; 95% CI (0.152, 0.674)] and patient stated inability to cope with Human Immunodeficiency Virus (HIV) [β = −1.029; 95% CI (−1.441, −0.617)] affected the Mental Health Summary Score (MHSS)
There is a need for studies to evaluate the impact of treatments on health-related quality of life (HRQoL) especially in diseases such as HIV associated with stigma, where there are concerns with the toxicity of treatments, and in HIV patients with combined morbidities, to guide future strategies (Oguntibeju, 2012; Balderson et al, 2013; Degroote et al, 2014; Vagiri et al, 2014, 2015; Rogers, 2015; Mafirakureva et al, 2016; Brandt et al, 2017)
Summary
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO Constitution of The World Health Organization, 2006). Diseases affect the psycho-social status of an individual by increasing the economic burden, psychological distress, and social unacceptability of patients especially with conditions associated with stigma, such as Human Immunodeficiency Virus (HIV) infection This nonphysical effect of HIV, and the associated medicines, can lead to despair and even non-adherence to treatment (Campos et al, 2009; National AIDS STI Control Programme [NASCOP], 2011). In Botswana at one stage nearly 50% of women aged between 30 and 34 years had HIV, which has potential implications for quality of life (QoL) and adherence to treatments if patients have concomitant non-communicable diseases (Rwegerera et al, 2018) This reflects the greater prevalence of HIV among women than men in sub-Sahara Africa, different to the populations typically seen in Western countries (Gaida et al, 2016; Kalemeera et al, 2016; Ayele et al, 2017a; Mataranyika et al, 2018). In Kenya, the incidence rate for new HIV infections was recently estimated at 137,200 with an estimated 1.88 million patients living with HIV (Wang et al, 2016)
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