Life Of People Living With HIV Research Articles

Turkish Translation and Cross-Cultural Validity of Whoqol-HIV Bref Tool.

The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory. In line with WHO guidelines, the tool was translated and tested on 189 PLWH from İstanbul Şişli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability. Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79). The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

Immunoregulatory molecule expression on extracellular microvesicles in people living with HIV.

People living with HIV (PLWH) now benefit from combined antiviral treatments that durably control viral replication. These antiretroviral treatments decrease mortality and improve quality of life in PLWH, but do not completely control the excessive non-specific activation of the immune system in PLWH. This chronic immune activation is a key element of HIV immunopathology that contributes to the pathophysiology of inflammatory comorbid conditions, such as cardiovascular disorders, cancer and autoimmune diseases. Circulating non-exosomal extracellular vesicles, also known as microparticles (MPs) are detected in these diseases and have been linked to immune activation. The objective of this study was to characterize the MPs present in PLWH and to assess their association with chronic immune activation. We performed flow cytometry for the complete phenotypic characterization of MPs from fresh plasma from PLWH and from people without HIV as the control group. The absolute number, size and cellular origin of MPs were evaluated. The immunoregulatory profile was determined by cell origin, for MPs derived from platelets (PMPs), monocytes (MMPs) and T lymphocytes (LMPs). PLWH had significantly more circulating MPs than controls, for MPs of all sizes originating from T lymphocytes, red blood cells, neutrophils, dendritic cells, B lymphocytes and endothelial cells. PMPs and MMPs were not more numerous in PLWH, but the immunoregulatory phenotypes of these MPs differed between PLWH and controls. These differences in immunoregulatory molecule expression profile were also observed for LMPs. PDL1, ICOSL, CCR5, TGFβ1, MHC classes I and II, TRAIL, CXCR4, OX40, DC-SIGN, CTLA4 and PDL2 were more strongly expressed on the surface of MPs from PLWH than on those from controls. MPs are an important element in intercellular communication, making it possible to transfer phenotypes and functions to immune cells. The significantly higher numbers of MPs expressing diverse immunomodulatory molecules in PLWH may make a major contribution to the maintenance and/or the development of immune-cell activation in these individuals.

Age group-based interventions to improve psychological outcomes in people living with HIV: A systematic review

People living with HIV (PLWH) experience higher psychological distress than the general population. Interventions to improve PLWH’s psychological condition need to be adjusted to the their age as each age group’s cognitive abilities are different. This systematic review aims to demonstrate age group-based interventions to improve psychological outcomes in PLWH. A search on articles (2014-2022) focused on experimental studies was conducted on Scopus, SAGE Journal, Science Direct, and PubMed. The searched articles tested interventions to improve psychological outcomes in PLWH and were published in English. The Joanna Briggs Institute (JBI) guidelines were used to assess their eligibility, and PRISMA diagram was used to compile the results of the search. Fifteen studies that matched the inclusion criteria were obtained, and they had experimental study designs. Several types of interventions were identified from the obtained literature. These interventions were designed according to their research subjects, and had been proven to have a significant effect on improving psychosocial conditions and quality of life in PLWH. Further research about age group-based interventions to improve psychological outcomes in PLWH is necessarily suggested. Future research is expected to be able to design interventions that focus on building resilience in individuals. The resilience is to make individuals manage their stress optimally. This may improve not only their psychosocial status but also their adherence to treatment and quality of life.

Isolated abnormal diffusing capacity for carbon monoxide (iso↓DLco) is associated with increased respiratory symptom burden in people with HIV infection.

An isolated reduction in the diffusing capacity for carbon monoxide (DLco; iso↓DLco) is one of the most common pulmonary function test (PFT) abnormalities in people living with HIV (PWH), but its clinical implications are incompletely understood. In this study, we explored whether iso↓DLco in PWH is associated with a greater respiratory symptom burden. Cross-sectional analysis. We used ATS/ERS compliant PFTs from PWH with normal spirometry (post-bronchodilator FEV1/FVC ≥0.7; FEV1, FVC ≥80% predicted) from the I AM OLD cohort in San Francisco, CA and Seattle, WA, grouped by DLco categorized as normal (DLco ≥lower limit of normal, LLN), mild iso↓DLco (LLN >DLco >60% predicted), and moderate-severe iso↓DLco (DLco ≤60% predicted). We performed multivariable analyses to test for associations between DLco and validated symptom-severity and quality of life questionnaires, including the modified Medical Research Council dyspnea scale (mMRC), the COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ), as well as between DLco and individual CAT symptoms. Mild iso↓DLco was associated only with a significantly higher SGRQ score. Moderate-severe iso↓DLco was associated with significantly higher odds of mMRC ≥2 and significantly higher CAT and SGRQ scores. PWH with moderate-severe iso↓DLco had increased odds of breathlessness, decreased activity, lower confidence leaving home, and less energy. Iso↓DLco is associated with worse respiratory symptom scores, and this association becomes stronger with worsening DLco, suggesting that impaired gas exchange alone has a significant negative impact on the quality of life in PWH. Additional studies are ongoing to understand the etiology of this finding and design appropriate interventions.

Diseases and Disparities: The Impact of COVID-19 Disruptions on Sexual and Reproductive Health Services Among the HIV Community in India.

People with HIV navigate numerous challenges to access healthcare in India. The lockdown in response to the COVID-19 pandemic presents further challenges in accessing sexual and reproductive health (SRH) services. This research explored the impact of the pandemic on SRH services, and the depth of disruptions faced by people living with HIV (PLHIV) in accessing treatment. Using purposive sampling with maximum variation technique, we recruited and conducted 150 telephonic in-depth interviews with PLHIV and HIV care providers (HCPs) from five states in India (Karnataka, Tamil Nadu, Maharashtra, Andhra Pradesh, and Telangana). The interviews were recorded, transcribed, coded, and analyzed using interpretative phenomenological analysis. Five main themes were identified: the effect of COVID-19 on (1) access to care, (2) quality of care, (3) social determinants of health, (4) system and community resilience, and (5) support required to address population-specific vulnerabilities. Despite the availability of free government treatment services during the pandemic, profound disruptions in the SRH services, particularly antiretroviral therapy and HIV care, were reported by PLHIV and HCPs. This qualitative study revealed how existing inequities in HIV treatment and care are exacerbated by the pandemic. These findings highlight that the pandemic response should be community-centered to prevent extreme disruptions in healthcare which will have a disastrous effect on the lives of PLHIV.

Views and preferences of people living with HIV about smoking, quitting and use of nicotine products.

People living with HIV (PLHIV) have a higher rate of smoking and experience a greater burden of tobacco-related disease than the general population. This study aimed to understand the role smoking plays in the lives of PLHIV, participants' views of traditionally available nicotine products (e.g., nicotine replacement therapy or NRT) and novel nicotine products (e.g., nicotine vaping products or NVPs) as both short-term quit aids and long-term substitutes for cigarettes. Semi-structured focus groups were conducted with PLHIV who smoked. Focus groups were transcribed and analysed using a combination of deductive and inductive thematic analysis. A brief questionnaire of nicotine product use and interest was also completed and the quantitative data presented using descriptive statistics. Fifty-four participants took part in 11 focus groups. Participants' views of smoking, quitting and nicotine products were diverse. Commitment to smoking and interest in quitting were categorised into three groups across a smoking-quitting continuum: committed to smoking, ambivalent about smoking and reluctantly smoking. NRT was criticised for a range of side effects and primarily considered as a short-term cessation aid. NVPs generated debate. NVPs that closely resembled cigarettes were viewed as the most acceptable product and were considered to be more suitable than NRT for long-term use. Understanding the unique needs, goals and views of PLHIV related to smoking, quitting smoking and using nicotine products could inform development of novel and tailored smoking interventions for PLHIV. NVPs should be further examined as potential long-term substitutes for PLHIV who are ambivalent about smoking. However, traditional smoking cessation assistance (approved cessation aids and counselling) is likely to be most appropriate for PLHIV who are reluctantly smoking.

Physiotherapists\u2019 awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study

BackgroundRecent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results.AimThis study aimed to explore physiotherapists’ awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions of current falls prevention strategies in the care of PLWH in selected regions of sub-Saharan Africa.MethodAn exploratory descriptive qualitative research method was employed to explore physiotherapists’ perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis.ResultsThe primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention, as perceived by the physiotherapists, were sub-optimal.ConclusionPhysiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH.

Factors Influencing Young Korean Men's Knowledge and Stigmatizing Attitudes about HIV Infection.

Stigma against people living with HIV (PLHIV) fosters depression and negatively impacts the quality of life in PLHIV and is a barrier to the whole process of treatment. This study aimed to identify the levels of knowledge and stigmatizing attitudes toward HIV infection among Korean men in their 20s and the factors influencing them. A cross-sectional design was used. Two hundred and eight Korean men in their 20s responded to self-report questionnaires that included items on knowledge and stigmatizing attitudes about HIV infection, subjective norms for safer sexual behaviors (SSBs), participants’ HIV-related characteristics, sex-related characteristics, and general characteristics. The mean score (±SD) for knowledge was 13.9 (±5.28) and for stigmatizing attitudes was 64.1 (±11.42). In quantile regression analysis, exposure to HIV-related information was a significant factor for knowledge in every quantile, and experience of HIV education was a significant factor in the 50th quantile. Experience of meeting PLHIV was a significant factor for stigmatizing attitudes in the 25th quantile, and subjective norms for SSB were a significant factor for stigmatizing attitudes in the 25th and 50th quantiles. Findings suggest the need for intervention to improve young Korean men’s knowledge, as well as intervention focusing on norms for SSB, to prevent stigmatizing attitudes.

"Moving Fourth": A Vision Toward Achieving Healthy Living with HIV Beyond Viral Suppression.

Since HIV has evolved from being a fatal illness to a chronic condition, this brings new challenges relating to long-term health, as increasing numbers of people living with HIV (PLHIV) navigate their lives beyond viral suppression. This review presents the challenges facing patients and health-care providers managing HIV in Europe today. We highlight the challenges that the evolving landscape in HIV brings, including managing an aging and more diverse population of PLHIV; this requires a shift from managing disease to managing health and may best be achieved by multidisciplinary teams in the long term. We introduce the concept of "health goals for me:" an individualized approach to the management of HIV, and use this as the basis for a proposed framework for assessing health-related quality of life for PLHIV. Our framework comprises a continuous cycle of "ask and measure," "feedback and discussion," and "intervention," based on collaboration between the health-care professional and patient. For improved long-term management of PLHIV, we consider that this framework should become an intrinsic part of HIV care in the future and that the "health goals for me" concept be used as a tool to facilitate healthy living for PLHIV beyond viral suppression.

Sword and Shield: Perceptions of law in empowering and protecting HIV-positive men who have sex with men in Manila, Philippines

ABSTRACTLegal protections for people living with HIV (PLHIV) are important for protecting human rights and combatting stigma. While much focus has been on the pernicious impacts of criminalisation of HIV transmission or nondisclosure, little research has accounted for the ways in which perception of protective laws may affect the everyday lives of PLHIV. The Philippines has the fastest growing HIV epidemic in the Asia & Pacific region, with HIV-positive men-who-have-sex-with-men (HIV+ MSM) bearing the majority of cases, and has recently revised their legal protections for PLHIV. We present findings from interviews with 21 HIV+ MSM in Manila, Philippines. Overall, participants viewed legal protections as both empowering and protective. Empowerment was achieved as protections helped participants manage internalised stigma, feel as if they had a weapon to fight discrimination, and perceive a more equitable climate around HIV within broader society. While participants felt as though the law sent positive signals that the government wanted to protect PLHIV, they doubted the actual legal process of bringing suits, leading to harms. Overall, this research presents ways in which legal protections can considered in interventions to empower PLHIV and also identifies opportunities to improve research and advocacy in settings with similarly protective laws.

Development and validation of PozQoL: a scale to assess quality of life of PLHIV

BackgroundAdvances in medical treatment for HIV are driving major changes in HIV policy and practice, including the encouragement of intake and adherence to HIV antiretroviral treatment (ART) by people living with HIV (PLHIV) for both personal and public health benefits. However, there is increasing recognition that achieving these goals will require a concurrent focus on the broader psychological and social wellbeing of PLHIV. Increasingly calls are being been made to incorporate a stronger focus on quality of life (QoL) of PLHIV into HIV prevention policy.In order to achieve this goal, HIV community, support and healthcare services need a valid, short and practical way to evaluate QoL of PLHIV accessing their programs. Current QoL measures are either long, complex, restricted in their use, or expensive. To address these shortcomings, the PozQoL study aimed to develop, test and validate a short and freely available scale assessing QoL among PLHIV.MethodsDrawing on a literature review, the prioritisation of domains and development of the initial pool of items was conducted in consultation with PLHIV community organisations in Australia. The items covered health concerns, psychological, social, and functional wellbeing. Testing involved a baseline and a follow-up survey of 465 adult Australians living with HIV. Participants were recruited through social media and various community organizations nationwide. The survey included the pilot PozQoL scale and other validated measures of health and wellbeing.ResultsGuided by an Exploratory Factor Analysis and conceptual considerations, a 13-item scale was developed. The PozQoL scale demonstrated high levels of fit in a Confirmatory Factor Analysis, very good internal consistency, test-retest reliability, and concurrent validity with other measures that approximated different aspects of QoL.ConclusionThe PozQoL scale has been tested in a diverse sample of adult PLHIV living in Australia, demonstrating very good reliability and validity. The insights from PLHIV and other stakeholders supported the balancing of statistical rigour and conceptual accuracy. The scale is now ready to be implemented and field-tested across a range of community, support and healthcare programs for PLHIV. This will make a significant contribution to the evaluation and enhancement of programs for PLHIV.

Acceptability of HIV cure-related trials: the challenges for physicians and people living with HIV (ANRS-APSEC)

ABSTRACTEssential HIV cure-related clinical trials (HCRCT) have a potentially high-risk profile in terms of participants’ health, which could hinder enrollment by people living with HIV (PLWH) and healthcare professionals (HP). The ANRS-APSEC survey is part of the IAS “Towards an HIV cure” initiative, which promotes multidisciplinary research for a safe, affordable and scalable cure. The study objectives were to understand the psychosocial mechanisms underlying PLWH and HP viewpoints about future HCRCT. Six focus group discussions (three with PLWH (n = 21) and three with HP (n = 30)) were held in three French infectious disease units. From these, three perspectives on HCRCT were identified. The first involved beliefs and knowledge associating HCRCT with poorer health and quality of life for PLWH. The second concerned perceptions of HCRCT as a biological and epidemiological flashback to a situation when HIV infection was left uncontrolled. The third was characterized by aspects of historical HIV culture that embrace innovation.

Family interaction and social stigmatization of people living with HIV and AIDS in Puerto Rico

This article aims to describe the manifestation of HIV stigma in the family context and how this could impact the life of people living with HIV (PLWH). The data derive from a larger phenomenological study addressing manifestations of stigma in the lives of PLWH when interacting with the health sector. Nine focus groups were carried out in 2011 with PLWH (N=67). Eight themes emerged from the qualitative analysis. For the purpose of this article, we focus on the categories related to family dynamics: the negotiation of disclosure and non-disclosure, fear of the HIV virus and family dynamics, and life as a couple. Socio demographic information showed that 53% were between 44 to 54 years old, 80% were single, 51% were male, 42% did not complete a high school diploma, 82% were unemployed. Also, 82% described themselves as religious persons and 41% had lived with HIV for 10 years or less. Qualitative results show stigma is still present in the family context. PLWH experience fear of disclosure, discrimination, avoid initiating families or couple relationships, experience physical and verbal abuse from relatives, and even separation from other family members. After more than 30 years of the ongoing HIV epidemic, stigma is still manifested by family members with detrimental social and medical implications for PLWH. Research and educational efforts should continue addressing manifestations of stigma among family members of PLWH.

Hypertension in people living with HIV.

This review describes what is known concerning the burden of hypertension among people living with HIV (PLHIV), and also addresses relevant topics with respect to its risk factors and clinical management. Hypertension is highly prevalent in HIV-positive populations, and may be more common than in HIV-negative populations. Risk factors contributing to the development of hypertension in PLHIV include demographic factors, genetic predisposition, lifestyle, comorbidities such as obesity, antiretroviral therapy-related changes in body composition, and potentially also immunodeficiency, immune activation and inflammation, as well as effects from antiretroviral therapy itself. Clinical management of hypertension in PLHIV requires awareness for drug-drug interactions between antiretroviral drugs and antihypertensive drugs. Awareness, treatment, and control of hypertension in PLHIV is currently suboptimal and should be improved. The burden of hypertension among PLHIV is high and its pathophysiology most likely multifactorial. Elucidating the exact pathophysiology of hypertension in PLHIV is vital as this may provide new targets to impact and improve clinical management. In the meantime, efforts should be made to improve hypertension management as per existing clinical guidelines in order to safeguard cardiovascular health and quality of life in PLHIV.

What Would an HIV Cure Mean to You? Qualitative Analysis from a Crowdsourcing Contest in Guangzhou, China.

Much HIV cure social science research has focused on high-income countries. Local key population perspectives, especially from people living with HIV (PLHIV), are needed in low- and middle-income countries. We organized an open contest soliciting responses from key populations, including PLHIV, about what a cure would mean in their lives. Tailored in-person events and social media were used to engage PLHIV, men who have sex with men (MSM), people who inject drugs, and local residents. We received 471 contributions over 4 months. Our thematic analysis showed that many people perceived that a cure would sterilize HIV and bring about new life for PLHIV. Many individuals believed a cure would decrease PLHIV discrimination and many MSM perceived a cure would decrease MSM discrimination. Some participants noted that a cure could help improve interpersonal relations, particularly with families and partners. Many individuals envisioned HIV cure as a panacea to bring about social stability. Some participants also anticipated changes in attitudes toward sex that may result in increased condomless sex. Our findings suggest a continued need for careful management of patient expectations and community engagement.

Reducing Stigma-Driven Health Disparities in People Living with HIV (PLWH): A Literature Review

Introduction: Research has found that HIV-related stigma has numerous negative impacts on the lives of people living with HIV (PLWH). Although there are more resources than ever dedicated to HIV/AIDS efforts, stigma continues to be a major factor challenging the prevention and treatment of HIV today. Understanding the impacts of stigma on health outcomes and quality of life in PLWH is essential to address the global HIV epidemic and reduce health disparities. Search Strategy: We conducted a secondary meta-analysis of existing research that discussed and evaluated the impacts of HIV-related stigma and discrimination on PLWH. We searched the following databases for peerreviewed articles: EBSCO Host, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PubMed. We also obtained reports from Centers for Disease Control (CDC), Food and Drug Administration (FDA), Office of the High Commissioner for Human Rights (OHCHR), World Health Organization (WHO), and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Results: Our review of the literature revealed that HIV-related stigma is a socially constructed global phenomenon that reflects social and cultural tradition. Most current stigma-reduction interventions are designed to address individual-level stigma (symbolic stigma). While this has contributed to improvements in individual attitudes towards PLWH, interventions at the individual level alone do not address the macro-level attitudes and societal norms that influence individual ideals and behaviors. Conclusion: Findings in the literature review suggest that because of the pervasiveness of HIV-related stigma globally, addressing stigma is imperative to the HIV response. It also suggests that interventions that address stigma at the structural level and target multiple domains might have a more profound impact on HIV-related health outcomes.

Anti-Retro Viral Therapy (ART) Adherence and Factors affecting Adherence among People living with HIV (PLHIVs)

Background: Anti-retroviral therapy (ART) improves the quality of life in HIV infected persons worldwide. To achieve optimal results from ART high levels of adherence is essential. But various factors prevent PLHIVs in adhering to ART and get the fullest benefit out of it. Methods: A descriptive cross sectional study was conducted among 100 PLHIVs receiving ART for more than 1 year in a selected setting. Using structured interview schedule ART intake in the previous month and the factors that lead to non or poor adherence in the previous 1 year were assessed individually. Results: 77% of subjects had 100% adherence to ART in the previous month. Personal and family support, occupational, and institutional factors affected the ART adherence of PLHIVs. Discussion: Determining the level of adherence to ART, throws light on the utility of the service extended by the Government. The potential barriers identified help the stake holders to focus on those areas specifically, as adherence to ART improves the longevity, productivity and quality of life of PLHIVs.

Assessment of Knowledge, Attitude, and Practice of PLHIV receiving treatment at Teku ART Site, Kathmandu


 Background: HIV/AIDS has become a significant public health concern in Nepal. We have collected necessary information for assessing the level of knowledge, attitude, and practice of healthy behavior of People living with HIV (PLHIV), who seek treatment from this study site.
 Methods: Hospital based descriptive cross-sectional study was carried out on the assessment of knowledge, attitude, and practice which were critical in saving lives of PLHIV receiving treatment at Teku ART site, Kathmandu. Total 90 respondents were administered semi-structured questionnaire. The data and information collected were entered by the researcher into Excel and then later analyzed using SPSS.
 Results: The study showed that maximum respondents were male and between the ages of 38-47 years. The level of knowledge on HIV infection among the respondents was satisfactory and the level of knowledge on healthy behavior for saving their lives was found to be average. The majority of the PLHIV were aware of one or the other healthy behavior, and only some had no knowledge of them. Maximum (65.6%) had no knowledge of opportunistic infections which can be a risk to PLHIV. Similarly, the attitude of all the respondents was positive towards that healthy behavior and a maximum of the respondents practice healthy behavior such as regular intake of medicine, safe sex practice, intake of nutritious food, personal hygiene in their daily lives. But still some behaviors such as regular exercise, prevention of opportunistic infections were not practiced by the respondents.
 Conclusion: The study concluded that level of knowledge among PLHIV regarding healthy behavior was found satisfactory. But still emphasis must be given on improving knowledge and practice on some behaviors such as regular exercise, prevention of opportunistic infections.

Food insecurity, mental health and quality of life among people living with HIV commencing antiretroviral treatment in Ethiopia: a cross-sectional study.

BackgroundStudies from high-income settings show that both food insecurity and common mental disorders (CMDs) are associated with lower quality of life among people living with HIV (PLHIV). However, there is limited research among PLHIV in sub-Saharan Africa. In this study we tested the hypothesis that food insecurity and CMDs would be associated with poorer quality of life of PLHIV in Ethiopia.MethodsA cross-sectional study was carried out with 348 PLHIV who were initiating antiretroviral therapy recruited from two primary care centers and a tertiary Hospital in southwest Ethiopia. Food insecurity, CMD, and quality of life were measured using instruments adapted and validated in Ethiopia (Household Food Insecurity Access Scale, Kessler-6, and WHOQOL-HIV-BREF-ETH, respectively). Multiple linear regression analysis was used to identify factors associated with quality of life after adjusting for confounders.ResultsThe prevalence of severe household food insecurity among PLHIV was 38.7 %. After adjusting for confounders, severe food insecurity (β = -3.24, 95 % CI: -6.19; -0.29) and higher levels of CMD symptoms (β = -1.72 for each 1 point increase, 95 % CI: -1.94; -1.49) were associated with lower quality of life. Other factors associated with lower quality of life were advanced HIV disease (β = -3.80, 95 % CI: -6.18; -1.42), and being underweight (BMI = 17.0 – 18.5 kg/m2) (β = -3.45, 95 % CI: -6.18; -0.71). Owning more household assets was associated with higher quality of life (β = 0.99 for owning one more asset, 95 % CI: 0.09; 1.89).ConclusionPoor mental health and food insecurity are associated with lower quality of life in PLHIV. There is a need for longitudinal studies to elucidate the pathways linking CMD, food insecurity and quality of life.

Factors That Affect Quality of Life among People Living with HIV Attending an Urban Clinic in Uganda: A Cohort Study.

IntroductionWith the availability of antiretroviral therapy (ART) and primary general care for people living with HIV (PLHIV) in resource limited settings, PLHIV are living longer, and HIV has been transformed into a chronic illness. People are diagnosed and started on treatment when they are relatively well. Although ART results in clinical improvement, the ultimate goal of treatment is full physical functioning and general well-being, with a focus on quality of life rather than clinical outcomes. However, there has been little research on the relationship of specific factors to quality of life in PLHIV. The objective of this study was to investigate factors associated with quality of life among PLHIV in Uganda receiving basic care and those on ART.MethodsWe enrolled 1274 patients attending an HIV outpatient clinic into a prospective cohort study. Of these, 640 received ART. All were followed up at 3 and 6 months. Health related quality of life was assessed with the MOS-HIV Health Survey and the Global Person Generated Index (GPGI). Multivariate linear regression and logistic regression with generalized estimating equations were used to examine the relationship of social behavioral and disease factors with Physical Health Summary (PHS) score, Mental Health Summary (MHS) score, and GPGI.ResultsAmong PLHIV receiving basic care, PHS was associated with: sex (p=0.045) - females had lower PHS; age in years at enrollment (p=0.0001) - older patients had lower PHS; and depression (p<0.001) - depressed patients had lower PHS. MHS was only associated with opportunistic infection (p=0.01) - presence of an opportunistic infection was associated with lower MHS. For the GPG the associated variables were age (p=0.03) - older patients had lower GPGI; education (p=0.01) – higher education associated with higher GPGI; and depression - patients with depression had a lower GPGI (p<0.001). Among patients on ART, PHS was associated with: study visit (p=0.01), with increase in time there was better PHS, and this also improved with increase in education level (p=0.002). Patients with WHO disease stage 3&4 had a lower PHS compared to patients at stage 1&2 (p=0.006), and depressed patients had lower PHS (p<0.001). MHS improved from baseline to six month study visit (p<0.001), and females had lower MHS compared to males (p=0.01). GPGI was associated with higher income (p=0.04), alcohol use was associated with lower GPGI (p=0.004), and depressed patients had a lower GPGI (p<0.001).ConclusionQuality of life improved over time for PLHIV on ART. Regardless of treatment status, PLHIV with depression or low education level and female gender were at risk of having a poor quality of life. Clinicians and policy makers should be aware of these findings, and address them to improve quality of life for PLHIV.