Functional Assessment Of HIV Infection Research Articles

An empirical test of the chronic illness quality of life model: the prominent role of barrier to health care and social support

ABSTRACT The Chronic Illness Quality of Life (CIQOL) model highlights satisfaction with life in individuals with a chronic illness (i.e., HIV-related diseases) determined by factors such as barriers to health care, AIDS-related discrimination, social support, physical well-being, and engagement coping. Despite the empirical evidence supporting the CIQOL model, its validation in the Iranian population has not yet been conducted. This study aimed to validate the CIQOL model among Iranian patients with HIV-related diseases. Four hundred fifty-two patients completed the study questionnaire including Barriers to Care Scale (BACS), Satisfaction with Life Scale (SWLS), Chronic Illness Anticipated Stigma Scale (CIASS), Social Provision Scale (SPS), The Functional Assessment of Human Immunodeficiency Virus Infection (FAHI), and the Brief COPE Scale. Structural equation modeling (SEM) was used to analyze the data. The assumed model demonstrated an acceptable level of fit to study data. Findings showed that this model could explain 39% of variances in life satisfaction in Iranian patients with HIV-related diseases. Therefore, in psychological interventions aimed at enhancing life satisfaction, the CIQOL model factors especially barriers to health care and social support can be taken into consideration.

1417. The Impact of Psychosocial Factors on ART Adherence is Mediated by Poverty in Older Adults Living With HIV

Abstract Background Despite decades of work evaluating multiple interventions to improve ART adherence, viral load suppression in the U.S. remains far below Ending the HIV Epidemic goals. Previous research demonstrates that income and other factors, including social well-being (SWB), resilience, and exercise, are correlated with ART adherence. However, it is unclear how these factors interact with income to impact adherence in older adults living with HIV (OALWH). Methods Self-reported outcome measures from the Aging with Dignity, Health, Optimism, and Community (ADHOC) cohort were collected from November 2017 to June 2019. Adherence was measured using the Brief Adherence Self-Report Questionnaire, depression using the Patient Health Questionnaire-2, SWB using the Functional Assessment of HIV Infection, and resilience using the Connor-Davidson Resilience Scale. Face-valid questions provided data on household income, race, sexual orientation, # of ART pills daily, and exercise. Linear regressions assessed the associations between these variables and adherence. Mediation analysis using bootstrapping assessed the significance of the mediation effects of income on these variables. Results For 1,039 ADHOC participants, average age was 59 years, 86% were male, 69% were White, and mean adherence was 96.2% (SD=11.2). In bivariate analyses, depression, SWB, exercise, resilience, White race, # ART pills daily, and sexual orientation were each significantly correlated with both ART adherence and income. Interestingly, depression, SWB, resilience, and exercise became non-significant predictors of adherence after adjusting for the effects of income. Mediation analysis with bootstrapping demonstrated significant causal mediation effects of income on depression and adherence (B=-0.14, 95% CI (-0.25 – -0.04)), SWB and adherence (B=0.03, 95% CI (0.01 – 0.05)), resilience and adherence (B=0.15, 95% CI (0.04 – 0.27)), and exercise and adherence (B=0.002, 95% CI (0.0007-0.003)). Conclusion In OALWH, household income mediates the relationship between ART adherence and depression, SWB, resilience, and exercise. Therefore, interventions to improve adherence must address the causal role of income and focus on providing low-income patients with economic support to help lift them out of poverty. Disclosures Peter J. Mazonson, MD, MBA, ViiV Healthcare: Grant/Research Support Maile Y. Karris, MD, Gilead Sciences: Grant/Research Support|Gilead Sciences: I have received honorarium to speak at conferences|ViiV Healthcare: Grant/Research Support Emily Huang, MPH, ViiV Healthcare: Grant/Research Support Jeff Berko, MPH, ViiV Healthcare: Grant/Research Support Frank Spinelli, MD, Gilead Sciences: Employee|ViiV Healthcare: former employee Andrew Zolopa, MD, ViiV Healthcare: full time employee|ViiV Healthcare: Stocks/Bonds.

Correlates of health-related quality of life among adults receiving combination antiretroviral therapy in coastal Kenya

BackgroundHealth-related quality of life (HRQoL) is an important metric of perceived wellbeing in people living with HIV/AIDS (PLWHA). However, research on HRQoL among PLWHA in sub-Saharan Africa is limited. This study investigates factors associated with HRQoL among PLWHA in Kilifi, coast of Kenya.MethodsBetween February and April 2018, 450 adults living with HIV and on combined antiretroviral therapy (cART) between 18 to 60 years were sequentially recruited from an HIV-specialized clinic. The Functional Assessment of HIV Infection (FAHI) questionnaire, previously adapted for assessing HRQoL in this setting, was slightly modified and administered to participants alongside other measures of sociodemographic, health and treatment characteristics in a face-to-face interview.ResultsLinear regression analyses indicated that depressive symptoms, HIV-related stigma, non-disclosure of HIV status, living alone, clinic inaccessibility, and presence of any current opportunistic infection were significantly associated with lower HRQoL scores at both the FAHI overall and sub-scale level. Higher physician empathy, male sex, and higher body mass index were significantly associated with better HRQoL scores at both FAHI overall and sub-scale level. Age and longer duration on cART were significantly associated with better HRQoL only at the sub-scale level.ConclusionsInterventions aimed at reducing depressive symptoms and HIV stigma, making HIV-related services more accessible, addressing opportunistic infections, strengthening social support systems, serostatus disclosure and put in place caring, respectful, and compassionate model of care are necessary to improve the HRQoL of PLWHA.

1257. Mental Health, Quality of Life, and Accessibility to Care Among Virally Suppressed People Living with HIV in the United States

BackgroundLife expectancy of people living with HIV (PLHIV) in the United States has improved dramatically in the last 25 years, and more than ever are virally suppressed (VS). However, HIV is a complex chronic condition associated with a myriad of concurrent conditions. The “Real-world Insights of PLHIV Shared through Electronic devices” (RISE) study was a cross-sectional survey designed to obtain an up-to-date understanding of the unmet needs in virally suppressed PLHIV.MethodsParticipants completed the survey on a mobile application downloaded directly to their device. The survey included a sociodemographic and clinical section, and seven validated patient-reported outcome measures. The current analysis was limited to Functional Assessment of HIV Infection (FAHI) total and domain scores as well as the Patient Satisfaction Questionnaire (PSQ-18) accessibility and convenience domain. A two-point difference in the FAHI domain scores and a five-point difference in the total score are generally considered clinically meaningful and were used as benchmarks for comparisons.ResultsMost of the sample (n = 1,226) were virally suppressed (VS) (92%), male (81%), White (53%), homosexual (77%), and reported some type of mental health condition (90%). On average participants were 46±11 years old and had been diagnosed with HIV 14.3±9.6 years ago. VS participants with a mental health condition reported significantly lower quality of life (QoL) than participants without a mental health condition, except on the FAHI social well-being and cognitive functioning scores (Table 1). VS participants with depression reported lower QoL even when controlling for key demographic variables (F= 278.3; P < 0.0001; R2=.77).ConclusionWhile treatment and care for PLHIV has improved in recent years, there remain significant unmet needs. Although achieving VS significantly improves the QoL of PLHIV, additional attention should be placed on the role of mental health and well-being, especially as individuals age while living with HIV. These results highlight the need to understand factors contributing to decreased HRQoL in PLHIV, and the importance of addressing these factors in clinical care. Disclosures All authors: No reported disclosures.

Balance as an assessment of health-related quality of life in people living with HIV

Background: Balance and cognitive decline are impairments in people living with HIV (PLWH). These impairments predispose to fall-related injuries, affecting health-related quality of life (HRQoL). This study assessed standing balance and cognition after a three-month fitness program and its relationship to HRQoL. Methods: Fifty-four PLWH participating in a community-based fitness program participated in this study. Standing balance with eyes open and eyes closed was measured with a pressure mat. Cognition was assessed using the HIV dementia scale (HDS), while the Functional Assessment of HIV Infection (FAHI) was used as a measure of HRQoL. Paired t-tests compared balance values while linear regression explored the association between balance and HDS scores with HRQoL. Results: Balance values with eyes open improved significantly (p=0.04). Linear regression showed a significant association between the three predictors and HRQoL (r = .50; p = .017). Conclusions: Standing balance and mental status play a significant role in HRQoL in PLWH.

547. Results of Patient-Reported Outcome Data From the Phase III BRIGHTE Study of Fostemsavir

BackgroundThe Phase 3 BRIGHTE study evaluated fostemsavir in heavily treatment experienced HIV-1 patients failing their current antiretroviral (ARV) regimen and unable to construct a viable regimen from remaining available agents. Week 24 efficacy and safety have been previously reported—fostemsavir resulted in virological and immunological improvements and was generally well tolerated. The objective of this abstract is to report analyses of patient-reported outcomes (PROs) from BRIGHTE.MethodsBRIGHTE included two cohorts: the randomized cohort (RC) had one to two classes of ARV therapy available; the nonrandomized cohort (NRC) had no ARV classes available. RC patients received fostemsavir or placebo + existing failing regimen for 8 days, and thereafter fostemsavir + optimized background therapy (OBT); NRC received fostemsavir + OBT throughout. PROs included the Functional Assessment of HIV Infection (FAHI), the EuroQol-5D-3L (EQ-5D) and associated visual analogue scale (VAS).ResultsBoth cohorts had advanced disease, low CD4 counts (median of 99.5 in RC and 41 in NRC) and high proportions of patients with AIDS (84% in RC and 90% in NRC). This was reflected in fairly low baseline FAHI scores. Improvements from baseline to Week 24 were observed in FAHI total score, physical well-being and emotional well-being subscales, with limited/no change in function/ global well-being, social well-being and cognitive function. Improvements in the RC were close to published values for minimum clinically important differences, with smaller improvements in the NRC. EQ-5D utilities were similar at Week 24 to baseline in both cohorts, with improvements in the EQ-5D VAS (11% in the RC, 8% in the NRC).FAHIEQ-5DCohortTotal ScorePhysical Well-BeingEmotional Well-BeingFunction and Global Well-BeingSocial FunctioningCognitive FunctioningUtility Score (US Norms)VASRCBaseline122.530.726.235.322.18.40.83174.6Change from Baseline (CFB) Week 24+6.7+2.8+3.1+1.0−0.10.0+0.02+8.1NRCBaseline114.329.124.931.820.67.90.81870.8CFB Week 24+2.1+1.2+1.6+0.7−1.6+0.2+0.03+5.6ConclusionThe BRIGHTE study demonstrated improvements in PROs in heavily treatment experienced HIV patients, complementing previously published efficacy and safety results.Disclosures C. Proudfoot, viiv healthcare: Employee, Salary. P. Ackerman, ViiV Healthcare: Employee, Salary. C. Llamoso, ViiV Healthcare: Employee, Salary. A. Clark, ViiV healthcare: Employee, Salary. M. Murray, Viiv healthcare: Employee, Salary.

A mixed methods approach to adapting and evaluating the functional assessment of HIV infection (FAHI), Swahili version, for use with low literacy populations.

BackgroundDespite bearing the largest HIV-related burden, little is known of the Health-Related Quality of Life (HRQoL) among people living with HIV in sub-Saharan Africa. One of the factors contributing to this gap in knowledge is the lack of culturally adapted and validated measures of HRQoL that are relevant for this setting.AimsWe set out to adapt the Functional Assessment of HIV Infection (FAHI) Questionnaire, an HIV-specific measure of HRQoL, and evaluate its internal consistency and validity.MethodsThe three phase mixed-methods study took place in a rural setting at the Kenyan Coast. Phase one involved a scoping review to describe the evidence base of the reliability and validity of FAHI as well as the geographical contexts in which it has been administered. Phase two involved in-depth interviews (n = 38) to explore the content validity, and initial piloting for face validation of the adapted FAHI. Phase three was quantitative (n = 103) and evaluated the internal consistency, convergent and construct validities of the adapted interviewer-administered questionnaire.ResultsIn the first phase of the study, we identified 16 studies that have used the FAHI. Most (82%) were conducted in North America. Only seven (44%) of the reviewed studies reported on the psychometric properties of the FAHI. In the second phase, most of the participants (37 out of 38) reported satisfaction with word clarity and content coverage whereas 34 (89%) reported satisfaction with relevance of the items, confirming the face validity of the adapted questionnaire during initial piloting. Our participants indicated that HIV impacted on their physical, functional, emotional, and social wellbeing. Their responses overlapped with items in four of the five subscales of the FAHI Questionnaire establishing its content validity. In the third phase, the internal consistency of the scale was found to be satisfactory with subscale Cronbach’s α ranging from 0.55 to 0.78. The construct and convergent validity of the tool were supported by acceptable factor loadings for most of the items on the respective sub-scales and confirmation of expected significant correlations of the FAHI subscale scores with scores of a measure of common mental disorders.ConclusionThe adapted interviewer-administered Swahili version of FAHI questionnaire showed initial strong evidence of good psychometric properties with satisfactory internal consistency and acceptable validity (content, face, and convergent validity). It gives impetus for further validation work, especially construct validity, in similar settings before it can be used for research and clinical purposes in the entire East African region.

Quality of life among South African patients receiving antiretroviral therapy in the Western Cape Province.

Compared to patients not receiving treatment, antiretroviral therapy (ART) users may experience a lower viral load, an increased CD4 count, slower disease progression, fewer opportunistic infections, and more rapid recovery time from HIV-related illnesses. As such, health related quality of life (HR-QOL) is likely to be considerably greater for ART users than patients not receiving treatment. The dearth of QOL research in sub-Saharan Africa brings into focus the need for and importance of documenting the various dimensions of well-being among persons living with HIV in this region of the world. We thus sought to report on the performance of South African patients enrolled in a public government funded antiretroviral therapy (ART) program. We administered the Functional Assessment of HIV Infection (FAHI) to a convenience sample of patients receiving ART in the Western Cape in South Africa. We used confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) to determine the factor structure of the FAHI amongst South African ART users. The CFA revealed a poor model fit of the data. However the EFA factor structure closely approximated the subscales of the measure, indicating the dimensions of physical, emotional, functional, and social well-being and cognitive functioning. We identified problematic items contributing to the poor model fit and contribute to the knowledge base on QOL amongst ART users in South Africa.

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

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. 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. 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. 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.

Impact of antiretroviral therapy on health-related quality of life among South African women in the CAPRISA 002 acute infection study.

Concerns are often raised regarding potentially adverse effects of antiretroviral therapy (ART) on health-related quality of life (HRQoL), but there is limited longitudinal data to prove this. Building on our prior investigation, we examined the impact of ART on HRQoL among HIV-infected South African women with extensive follow-up in the CAPRISA 002 Acute Infection Cohort Study. Overall HRQoL and five sub-domains [physical well-being (PWB), emotional well-being (EWB), functional and global well-being (FGWB), social well-being (SWB) and cognitive functioning (CF)] were assessed using the Functional Assessment of HIV Infection (FAHI) instrument. Our analyses comparing FAHI scores between pre-ART (established infection) and ART phases using paired Wilcoxon signed-rank tests and adjusted mixed-effects regression models revealed improvements on ART in overall HRQoL, and in PWB, EWB, and SWB, but not in FGWB and CF. No long-term adverse impact of ART on HRQoL was detected, providing additional non-biomedical support to early treatment strategies.

Health-related quality of life dynamics of HIV-positive South African women up to ART initiation: evidence from the CAPRISA 002 acute infection cohort study.

Few studies have investigated the long-term dynamics in health-related quality of life (HRQoL) among HIV-positive persons from acute infection. From 2004, 160 women were enrolled into the CAPRISA 002 Acute Infection study at two sites in the province of KwaZulu-Natal and underwent 3-6 monthly HRQoL assessments using the functional assessment of HIV infection (FAHI) instrument. Overall and 5 sub-scale FAHI scores [physical well-being (PWB), emotional well-being (EWB), functional and global well-being (FGWB), social well-being (SWB) and cognitive functioning (CF)] were calculated up to antiretroviral therapy (ART) initiation and scores at enrollment were compared to the acute, early and established infection phases. Mixed-effects regression models adjusting for behavioral and clinical factors were applied to assess HRQoL trends and the proportion of women meeting minimally important differences was calculated. Our analyses revealed that overall/sub-scale scores improved over time, except from PWB and CF. A higher educational status, contraceptive use and a higher BMI were the strongest predictors of higher overall/sub-scale FAHI scores. CD4 count and HIV viral load were strongly associated with PWB and CF, but not overall FAHI and other sub-scales. Women newly diagnosed with acute HIV infection face profound HRQoL challenges. While early ART delivery may be important for PWB and CF, factors such as education, contraception provision and good nutritional status should be promoted to maximize HRQoL in HIV positive individuals.

Reliability and validity of the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) in patients with drug and alcohol use disorders

Human Immunodeficiency Virus (HIV) and substance use disorders can both significantly impact a patient's quality of life (QOL), and it is, therefore, important to assess QOL throughout treatments for these chronic conditions. This study evaluated the psychometric properties of the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) in 170 HIV-positive patients who participated in a substance abuse treatment study. Internal consistency of the FAHI was good. Convergent and discriminant validity were generally supported with comparisons to other patient-reported measures. FAHI scores were not significantly associated with viral loads or CD4 counts, and they were similar in patients with and without AIDS. Patients who achieved longer durations of drug and alcohol abstinence during treatment reported better QOL post-treatment. The FAHI appears to be a reliable and valid measure for assessing QOL in HIV-positive patients with concurrent drug and alcohol use disorders.

Health-Related Quality of Life in the Gender, Race, And Clinical Experience Trial

Background. We report health-related QoL (HRQoL) from GRACE (Gender, Race, And Clinical Experience) study by sex and race over 48 weeks. Methods. 429 treatment-experienced adults (HIV-1 RNA ≥ 1000 copies/mL) received darunavir/ritonavir 600/100 mg twice daily plus an appropriate background regimen. QoL was measured by the Functional Assessment of HIV Infection (FAHI) questionnaire. Results. 67% women and 77% men, including 67.4% black, 76.0% Hispanic, and 73.8% white patients, completed the trial. Baseline total FAHI scores were similar between sexes and races. Total FAHI of the entire population improved by Week 4 (P < .05); near-maximum changes obtained by Week 12 were maintained through Week 48. Women and black patients demonstrated larger improvements in total FAHI versus men, and Hispanic and white patients, respectively. Conclusion. HRQoL improved in all sex and racial/ethnic groups. Sex-based and race-based differences in improvements in FAHI subscales may provide insight into subtle differences of HIV-1 and treatment on HRQoL in different populations.

Factors influencing the quality of life in patients with HIV in Malaysia

The aim of this study was to determine the socio-demographic, clinical and psychological factors influencing the quality of life (QOL) in patients with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS). This was a cross-sectional study on 271 patients with HIV infection attending an HIV clinic in Kota Bharu, Malaysia. Participants completed the Malay version of the Functional Assessment of HIV Infection (FAHI) and Malay Hospital Anxiety Depression Scale (HADS). The patients functioned satisfactorily in the physical domain. They were mostly impaired in the social domain. Those who acquired the HIV infection via a heterosexual route seemed to have a significantly lower social well-being, while those who acquired HIV via drug injection were not associated with losses in the overall QOL or any of its domains. Non-disclosure paradoxically had a greater effect on social well-being. About 38% had possible anxiety, depression or both, and these emotional disturbances were significantly associated with total FAHI and its five domains. Psychological and social well-beings were more affected than physical well-being in out-patients with HIV infection in Kota Bharu, Malaysia. The study suggests that the patients with HIV infection should receive better psycho-education and psychological intervention.

Psychometric evaluation of the functional assessment of HIV Infection (FAHI) questionnaire and its usefulness in clinical trials

To evaluate psychometric properties of the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) questionnaire, a 47-item disease-specific instrument evaluating Health-Related Quality of Life (HRQL) in human immunodeficiency virus (HIV)-infected patients. Treatment-experienced HIV-infected patients from two clinical programmes (N = 565; N = 1,096) completed the FAHI at Baseline and after 24 weeks of treatment. Psychometric properties of the FAHI were assessed in both trial populations, including minimal important differences (MIDs) calculations. Links between HRQL assessed by FAHI Total score, and biological endpoints were explored by regression analysis and mean score comparisons. Cronbach's alphas ranged from 0.72 to 0.94. Most items met convergent and discriminant validity criteria. Better FAHI scores were seen for patients in earlier HIV stages. Responsiveness was demonstrated with changes in FAHI scores significantly linked to change in EQ-5D score. Depending on methods used, MIDs ranged from 3.2 to 14 for FAHI Total score. Small association was found between FAHI Total score and CD4 count and viral load (r-square < 3%). Mean changes in FAHI scores were not statistically related to viral response. The FAHI demonstrated acceptable psychometric properties in two independent populations. HRQL assessment enabled detection of changes in patients' health status not revealed by traditional efficacy endpoints.

Effects of Etravirine Versus Placebo on Health-Related Quality of Life in Treatment-Experienced HIV Patients as Measured by the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) Questionnaire in the DUET Trials

Purpose: To study the effects of etravirine versus placebo on the health-related quality of life (HRQL) of HIV-infected patients.Method: HRQL of HIV-infected patients was measured using the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) questionnaire in two identically designed phase III clinical trials investigating efficacy and safety of etravirine as part of highly active antiretroviral therapy. Pooled analyses of covariance, adjusted for treatment group, baseline FAHI score, CD4 cell count, viral load, and enfuvirtide use helped investigate changes in FAHI scores between baseline and Week 24 in etravirine-treated (n = 599) and placebo-treated (n = 604) subjects. Responder analyses were also conducted.Results: Significant improvements with etravirine treatment were observed for FAHI physical, functional, emotional, and total scores (P < .001). These improvements were greater and statistically different from those with placebo (.013 <P < .033). Baseline FAHI scores were significantly linked to changes in FAHI scores, and CD4 cell count had a significant but small effect on changes in FAHI total and social scores. Predicted percentages of responders were slightly but not significantly higher for etravirine than for placebo (24%–42% vs 23%–40%, respectively, for FAHI total score).Conclusion: At 24 weeks, etravirine in combination with other antiretroviral agents demonstrated incremental improvements in HRQL compared to placebo.

Quality of life, characteristics and survival of patients with HIV and lymphoma

PurposeWe sought to compare the quality of life (QOL), characteristics, and survival of patients with non-Hodgkin lymphoma (NHL) with and without human immunodeficiency virus (HIV) infection.MethodsUsing the population-based cancer registry for Orange and San Diego Counties, We recruited 50 patients with HIV and systemic NHL (cases) and 50 age, sex and race-matched NHL patients without HIV (controls) diagnosed with NHL during 2002–2006. Patients completed a medical history survey and QOL instrument, the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) for cases and Functional Assessment of Cancer Therapy-General (FACT G) for controls.ResultsHIV-infected patients had worse overall QOL and survival than uninfected patients. QOL differences were more marked in the areas of functional, physical and social well-being than in the area of emotional well-being. HIV-infected patients had lower income and were less likely to have private insurance and more likely to have diffuse large B cell histology than uninfected patients.ConclusionHIV-infected NHL patients had worse QOL and survival than uninfected patients, due to a combination of co-morbidity, aggressive histology and lack of social support. However, their emotional well-being was comparable to that of uninfected NHL patients and better than historical norms for the HIV-infected.

Effects of Etravirine Versus Placebo on Health-Related Quality of Life in Treatment-Experienced HIV Patients as Measured by the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) Questionnaire in the DUET Trials

Effects of Etravirine Versus Placebo on Health-Related Quality of Life in Treatment-Experienced HIV Patients as Measured by the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) Questionnaire in the DUET Trials

The Combined Effect of Relaxation Response and Acupuncture on Quality of Life in Patients with HIV: A Pilot Study

Treatment advances have transformed human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) into a chronic manageable disease; quality of life (QoL) has become an important health outcome. Some studies have shown the individual effects of acupuncture and the relaxation response (RR) in improving QoL of patients with HIV/AIDS. In light of the presumed shared features of acupuncture and the RR, we conducted a pilot study to examine the effects of adding the RR to usual acupuncture treatment on improving the QoL of HIV/AIDS patients. Two-arm double-blind randomized controlled trial. SETTINGS/LOCATION AND SUBJECTS: We enrolled 119 patients with HIV/AIDS (mean age 46 years, 85% male) who had at least 1 of the highly prevalent HIV-related symptoms and who were receiving acupuncture treatment in an acupuncture clinic in Boston, MA. We randomized patients into intervention (N = 58) and control (N = 61) groups. All participants received individualized acupuncture treatments prescribed by their acupuncturists. While receiving acupuncture treatment, the intervention group wore earphones to listen to tapes with instructions to elicit the RR followed by soft music that was routinely played in the clinic; the control group listened only to soft music. Three (3) QoL scales: the Medical Outcomes Study HIV health survey, the Functional Assessment of HIV Infection, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, measured at baseline, 4-week, 8-week, and 12-week follow-ups. At the 12-week follow-up, the intervention group showed significant improvements in emotional (p = 0.0002), spiritual/peace (p = 0.02), physical (p = 0.003) and mental health (p = 0.0003) QoL from baseline. Results of mixed effects regression models indicated linear trends of improvement over time in these dimensions of QoL for the intervention group (p < 0.02). In the control group, the only significant improvement was observed in the emotional QoL (p < 0.01). The intervention group showed trends of greater improvements than the control group (p = 0.07 for 12-week physical health QoL). Data from this pilot trial suggested that adding the RR to acupuncture may enhance improvement in QoL of patients with HIV/AIDS. Further investigation on this putative synergistic effect is warranted.

The Health Related Quality of Life Outcomes of English and Spanish Speaking Persons Living with HIV/AIDS from the Continental United States and Puerto Rico

Recent evidence indicates that HIV disproportionately affects ethnic minorities, youth, and women. The present study sought to further understand how sociodemographic and clinical factors impact the health-related quality of life (HRQL) of people living with HIV/AIDS (PLWHA) from the continental United States and Puerto Rico. Two hundred seventy-three participants (87% men, 13% women; 59% Hispanic, 25% black non-Hispanic, 16% white non-Hispanic) completed Spanish or English versions of the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI), an illness-specific measure of HRQL. Univariate and multivariate regression analyses were performed using age, gender, ethnicity, level of education, insurance type, language preference, living arrangement, literacy level, antiretroviral status, CD4+ T cell count, and time since diagnosis as independent variables. Four subscales from the FAHI, physical, emotional, social, and functional/general well-being, were analyzed as dependent variables. Men and Spanish speaking participants reported better physical well-being (p < 0.001). Men also reported better functional well-being (p < 0.05). Participants with a lower CD4+ T cell count, Spanish speakers, and White participants reported better emotional well-being (p < 0.001). Participants who lived with others, had a lower CD4+ T cell count, or were white reported better social well-being (p < 0.001). These results suggest that sociodemographic and clinical factors influence quality of life in PLWHA. Women appear to be particularly vulnerable to adverse quality of life impacts in the physical domains, and ethnic minorities appear vulnerable to adverse impacts in the psychosocial domains.