Medical Outcomes Study HIV Health Survey Research Articles

Quality of Life of Patients With Advanced HIV/AIDS: Measuring the Impact of Both AIDS-Defining Events and Non-AIDS Serious Adverse Events

To investigate the relative magnitude and duration of impact of AIDS-defining events (ADEs) and non-AIDS serious adverse events (SAEs) on health-related quality of life (HRQoL) among patients with advanced HIV/AIDS. We use data from OPTIMA (OPTions In Management with Antiretrovirals), a multinational, randomized, open, control, clinical management trial of treatment strategies for patients with multidrug-resistant HIV and advanced immune disease. Longitudinal models were used to determine the effects of ADEs and SAEs on HRQoL across periods before, during, and after event onset. The Medical Outcomes Study HIV Health Survey (MOS-HIV) physical and mental health summary scores (MOS-PHS and MOS-MHS), EQ-5D, and the Health Utilities Index Mark 3 HRQoL measures were all assessed at regular follow-up intervals during the trial. ADEs occurred much less frequently than SAEs (n = 147 vs. n = 821) in the study sample population of 368 patients, during median follow-up of 3.96 years. Although both ADEs and SAEs had significant negative impacts on HRQoL, SAEs had at least as large an impact upon HRQoL as ADEs when both were included in a multivariate linear regression model, controlling for other covariates. However, the effect of ADEs on HRQoL was more persistent, with larger magnitude of effect across all instruments in time intervals further from the onset of the event. Non-AIDS SAEs occurring in patients with late-stage HIV/AIDS seem to have at least as important an immediate impact on patient HRQoL as ADEs; however, the impact of ADEs seems to be more persistent. Our findings call for a greater emphasis on the detection and active prevention of non-AIDS SAEs in patients with late-stage HIV/AIDS.

Reliability and validity of two HIV/AIDS-specific quality of life instruments adapted for use in HIV-positive Zimbabweans

We sought to assess the reliability and construct validity of the HIV/AIDS-Targeted Quality of Life instrument (HAT-QoL) and the Medical Outcomes Study HIV Health Survey (MOS-HIV) adapted for use in Shona-speaking rural Zimbabwe. HAT-QoL and MOS-HIV were translated and culturally adapted into Shona, and administered to a convenience-sample of 400 patients with HIV-related opportunistic infections. HIV disease severity and bereavement history were assessed. Factor analysis of the HAT-QoL items produced seven factors that were nearly identical to the factor structure reported for an American sample that was the basis for the current HAT-QoL scales. Factor analysis of the MOS-HIV scales resulted in a single factor, not the expected two-factor structure (physical and mental). Convergent and discriminant validity assessments confirmed, in general, that similar Shona HAT-QoL and MOS-HIV dimensions were correlated and dissimilar ones not correlated. Construct validity assessments indicated that, on the whole, most Shona HAT-QoL and MOS-HIV dimensions were capturing anticipated subgroup differences. The exceptions were the Shona MOS-HIV dimensions of general health perceptions, cognitive function, and the quality of life (QoL) item. The reliability and validity of most Shona-adapted HAT-QoL and MOS-HIV dimensions suggest that both instruments are likely useful in measuring the QoL of rural, Shona-speaking populations in Zimbabwe, Mozambique, Zambia, and Botswana.

Health-Related Quality of Life in a Randomized Trial of Antiretroviral Therapy for Advanced HIV Disease

To assess and compare alternative approaches of measuring preference-based health-related quality of life (HRQoL) in treatment-experienced HIV patients and evaluate their association with health status and clinical variables. Cross-sectional study. Twenty-eight Veterans Affairs hospitals in the United States, 13 hospitals in Canada, and 8 hospitals in the United Kingdom. Three hundred sixty-eight treatment-experienced HIV-infected patients enrolled in the Options in Management with Antiretrovirals randomized trial. Baseline sociodemographic and clinical indicators and baseline HRQoL using the Medical Outcome Study HIV Health Survey (MOS-HIV), the EQ-5D, the EQ-5D visual analog scale (EQ-5D VAS), the Health Utilities Index Mark 3 (HUI3), and standard gamble (SG) and time trade-off (TTO) techniques. The mean (SD) baseline HRQoL scores were as follows: MOS-HIV physical health summary score 41.70 (11.16), MOS-HIV mental health summary score 44.76 (11.38), EQ-5D 0.77 (0.19), HUI3 0.59 (0.32), EQ-5D VAS 65.94 (21.71), SG 0.75 (0.29), and TTO 0.80 (0.31). Correlations between MOS-HIV summary scores and EQ-5D, EQ-5D VAS, and HUI3 ranged from 0.60 to 0.70; the correlation between EQ-5D and HUI3 was 0.73; and the correlation between SG and TTO was 0.43. Preference-based HRQoL scores were related to physical, mental, social, and overall health as measured by MOS-HIV. Concomitant medication use, CD4 cell count, and HIV viral load were related to some instruments' scores. On average, preference-based HRQoL for treatment-experienced HIV patients was decreased relative to national norms but also highly variable. Health status and clinical variables were related to HRQoL.

Development of the Perceived Stress Scale for People Living with HIV/AIDS in China

Stress among people living with HIV/AIDS (PLWHA) is associated with psychological morbidity. There are only a few stress scales specially developed for PLWHA and none of them is in Chinese. This study develops and validates a new Chinese Perceived Stress Scale among PLWHA (PSSHIV) in Shenzhen of Guangdong Province and Hengyang of Hunan Province in China during September 2006 through July 2007. In-depth interviews were administered to 58 PLWHA (33 males, mean age, 32) to generate the items, while 215 other PLWHA were interviewed in another survey to validate the instrument (136 males, mean age, 33). Exploratory factor analysis yielded 8 factors (percent variance explained, 71.47%), namely: social/psychological problems, sexual relationship, functional problems, social acceptance/rejection issues, work-related issues, family/offspring issues, accessibility to treatment, and treatment outcomes. The Cronbach alpha values ranged from 0.76 to 0.94 for the overall scale and the 8 subscales. The scores of the overall scale, the social/psychological problems, and functional problems subscales of the PSSHIV were significantly correlated with the Perceived Stress Scale (PSS), Depression, Anxiety and Stress Scale (DASS), and all domains of the Medical Outcomes Study HIV Health Survey (MOS-HIV) (correlation coefficient = 0.50 to 0.71 for positive correlations, and -0.73 to -0.21 for negative correlations, p < 0.05). The other 6 subscales of the PSSHIV were significantly correlated with the PSS, subscales of the DASS, and MOS-HIV (correlation coefficient = 0.16 to 0.39 for positive correlation, -0.58 to -0.15 for negative correlation, p < 0.05). This new instrument collected information from the PLWHA from qualitative interviews and the items are specific to the HIV/AIDS context. PSSHIV can be used for assessing the level of stress faced by PLWHA in China.

Health-Related Quality of Life and Tolerability in Treatment-Experienced HIV-1–Infected Patients on Tipranavir versus Comparator Regimens

Antiretroviral therapy including tipranavir boosted with ritonavir (TPV/r) has shown superior viral suppression and immunological response compared with comparator ritonavir-boosted protease inhibitor (CPI/r) regimens in treatment-experienced HIV-1-infected patients. This study assesses the influence of adverse events (AEs) on health-related quality of life (HRQOL) and change in HRQOL in patients treated with TPV/r versus CPI/r regimens. Changes in HRQOL over 48 weeks were assessed using Medical Outcomes Study HIV Health Survey (MOS-HIV) data combined from two randomized, open-label, Phase III studies (RESIST-1 and RESIST-2). Generalized estimating equations (GEE) were used to compare physical health and mental health summary scores and 10 subscale scores, and to compare scores of patients with and without AEs. To compare AE incidences in the two treatment groups, AEs were exposure-adjusted. There were 984 patients in the HRQOL analysis. AE occurrence and severity resulted in significantly lower MOS-HIV scores across both treatment arms (P<0.05). Overall incidence of AEs was higher in the CPI/r versus TPV/r group (562.8 versus 514.4 per 100 patient-exposure years); treatment-related AEs were more frequent in the TPV/r group (75.0 versus 56.6 per 100 patient-exposure years). HRQOL was maintained in patients on TPV/r over 48 weeks of treatment across all summary and subscale scores. Compared with CPI/r, TPV/r was associated with a significant but small (SD<0.2) improvement in pain scores (+4.8 points; P<0.05). HRQOL was maintained across both summary and all subscale scores from baseline to 48 weeks in the TPV/r and CPI/r treatment arms, despite the incidence of treatment-related AEs.

A large prospective study assessing injection site reactions, quality of life and preference in patients using the Biojector® vs standard needles for enfuvirtide administration*

To determine the severity of injection site reactions (ISRs), patient quality of life (QoL) and preference when enfuvirtide is administered by the Biojector (Bioject, Medical Technologies, Inc., Tualatin, OR, USA) relative to standard needles. A total of 201 HIV-positive patients on stable enfuvirtide-based therapy (n=184) or initiating such therapy (n=17) were evaluated prospectively after switching from standard needles to the Biojector system. Patients used needles for a minimum of 2 weeks prior to switching to the Biojector. Questionnaires to assess the incidence and severity of ISRs (31-item score) and QoL [Medical Outcomes Study HIV Health Survey (MOS-HIV)] were administered at baseline and following a minimum of 14 days of Biojector use. The median changes in ISR score and number of ISRs following a median of 1.0 month [interquartile range (IQR) 0.9, 1.3] of Biojector use were -3 (IQR -7, 1) and -1 (IQR -3, 1), respectively. The severity of pain (P<0.0001), induration (P<0.0001), pruritus (P<0.0001), nodules (P<0.0001) and erythema (P<0.0001) all decreased with the Biojector. Administration of enfuvirtide with the Biojector was associated with an improved patient QoL (P<0.0001), and was preferred by 72% of patients. Compared with needles, the Biojector was associated with a decreased severity of ISRs and improved QoL in patients taking enfuvirtide.

Validación mexicana de la escala MOS-HIV de calidad de vida en pacientes infectados por el VIH

To validate the Medical Outcomes Study HIV Health Survey (MOS-HIV) quality of life instrument for its application in clinical research in Mexico. The data for this study were collected between April, 2002, and February, 2004. An expert committee combined two Spanish-language translations of the MOS-HIV questionnaire. The new questionnaire's feasibility was assessed in a group of 32 HIV-infected persons by measuring how long they took to complete the questionnaire and the numbers of items they left unanswered. The questionnaire was then applied to a group of 120 HIV-positive patients and to a control group of 102 HIV-negative individuals. The following questionnaire characteristics were evaluated: (1) internal reliability (Cronbach alpha coefficient), (2) discriminant validity (the receiver operating characteristic (ROC) curves derived from the scores of the two groups), and (3) convergent validity (the Spearman correlation coefficients for the scores of the HIV-positive patients on the 11 MOS-HIV dimensions and their scores on the analog visual scale of the European Quality of Life 5-Dimensional format (EQ-5D) questionnaire, a list of symptoms, the viral load, and the CD4 cell count). The mean response time with the questionnaire was 10 minutes and 22 seconds, and the mean number of unanswered items was 0.62. With each of the 11 dimensions of the questionnaire, the Cronbach alpha coefficient was at least 0.75. The mean scores obtained by the two groups were different for 9 of the 11 dimensions, and the 95% confidence intervals of the areas under the ROC curves did not include the value of 0.5 for 8 of the dimensions. The absolute value of the Spearman correlation coefficient was less than 0.3 for the CD4 cell count and for the viral load, and it was greater than 0.3 for each dimension and the scores on the list of symptoms and on the analog visual scale of the EQ-5D questionnaire. The MOS-HIV measure is valid for use in clinical research among HIV-infected persons in Mexico.

Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda

We examined trends and predictors of quality of life (QOL) over 12 months among a prospective cohort of 947 HIV-1-infected adults initiating highly active antiretroviral therapy (HAART) between May 2003 and May 2004 in rural Uganda. Participants provided clinical, demographic and psychosocial data at baseline and every three months thereafter. Outcome measures included physical and mental health summary scores based on the Medical Outcomes Study-HIV Health Survey (MOS-HIV). Generalised estimating equations were used to assess magnitude of change in summary scores and factors associated with QOL. Of 710 women and 237 men enroled, the mean age was 38.7 years and mean baseline CD4 cell count was 124.1 cells/µL. At enrolment, physical and mental health summary scores were 39.2 and 40, respectively. By 12 months of HAART, scores increased by 11.2 points (p <0.001) and 7.4 points (p <0.001), respectively. For both scores, most gains were achieved by the third month of therapy. While several clinical, psychosocial and sociodemographic factors predicted QOL at HAART initiation, financial dependence on others was the only remaining predictor after controlling for time on HAART. Interventions to enhance the economic and employment opportunities of patients taking HAART in rural Africa may help maximise gains in QOL.

Características psicométricas de la escala de satisfacción con el tratamiento antirretroviral (ESTAR): estudio ARPAS (I)

To evaluate the psychometric characteristics, convergent validity and reliability of the antiretroviral treatment satisfaction scale (ESTAR, escala de satisfacción con el tratamiento antirretroviral). Patient satisfaction with ART was determined using the ESTAR questionnaire, developed in Spanish based on the English language version of the HIV-Treatment-Satisfaction Questionnaire (HIVTSQ). In order to evaluate this, internal consistency and test-retest reliability were measured. The construct analysis was performed by studying the covariance and correlation of the questions, and the convergent validity was assessed by using the MOS-HIV (Medical Outcomes Study HIV Health Survey) questionnaire as the standard, as was the content validity by the correlation between the ESTAR and the clinical and therapeutic variables. The ESTAR is structured in two dimensions (clinical satisfaction and satisfaction with lifestyle) with slight modifications to the original version; question 4, discarded in the original version, has been reworded in the Spanish version, and question 9 was deleted because of low communality. As regards the test-retest reliability, all the questions show significant intraclass correlation coefficients (p<0.001). The internal consistency shows higher values than the original version in the lifestyle dimension (a=0.81 vs. a=0.74) and in the total score (a=0.84 vs. a=0.82). With regard to convergent validity, the ESTAR presents significant correlations with the MOS-HIV as a whole and with different dimensions of it, especially the association with mental health, health distress and cognitive functioning dimensions. The ESTAR turns out to be a suitable, reliable instrument for evaluating satisfaction with ART by HIV+ patients.

A Randomized Trial of the Impact of a Programmable Medication Reminder Device on Quality of Life in Patients with AIDS

This 6-month randomized controlled trial evaluated the impact on quality of life (QOL) of a medication reminder device for patients with HIV. Patients were eligible if they had taken three or fewer highly active antiretroviral therapy (HAART) regimens or were treatment naïve. The intervention group received the Disease Management Assistance System (DMAS), a prompting device that verbally reminds patients at medication times and electronically records doses, and a monthly 30 minute adherence educational session. Controls received education only. QOL was measured at baseline and 6 months using the Centers for Epidemiologic Studies Depression Scale (CES-D), Instrumental Activities of Daily Living (IADLs), and the Medical Outcomes Study HIV Health Survey (MOS-HIV). At baseline, 62 patients completed surveys (31 control, 31 DMAS); at month 6, 48 patients completed surveys (23 control, 25 DMAS). At month 6, controls had improved QOL scores for CES-D, IADLs, physical health, general health, pain, QOL, and role functioning, while participants in the DMAS arm had some deterioration in QOL scores. These differences persisted after controlling for demographics, baseline CD4, and adherence. DMAS was associated with improved adherence but decreased QOL.

Validation of a Chinese version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) among Chinese people living with HIV/AIDS in Hong Kong

To evaluate the Chinese version of the 35-item Medical Outcomes Study HIV Health Survey (MOS-HIV) in Chinese people living with HIV/AIDS (PLWHA). A cross-sectional survey of 242 ethnic Chinese PLWHA in Hong Kong was conducted. Cronbach's alphas of the eight multi-item scales of the MOS-HIV ranged from 0.78 to 0.90. Item-total and inter-scale correlation coefficients were acceptable. Factor analysis of the MOS-HIV identified two factors (Mental Health Summary scores and Physical Health Summary scores, or MHS and PHS), accounting for 63% total variance. The PHS and MHS correlated significantly with the WHOQOL-BREF(HK) and the three sub-scales of Profile of Mood States used in this study. Both PHS and MHS were significantly associated with self-perceived change in health status. PHS but not MHS was associated with Karnofsky Performance Status scores. PHS was also associated with disease stage. The MOS-HIV however, did not distinguish between groups of different CD4 cell counts. It is likely that the quality of life of these PLWHA of different disease stages was good in general. There is a large demand for evaluating treatments and services programs offered to PLWHA in China. The validated Chinese MOS-HIV would facilitate such research activities.

Effect of long-cycle structured intermittent versus continuous HAART on quality of life in patients with chronic HIV infection

To examine the effect of repeated, long-cycle structured intermittent versus continuous HAART on health-related quality of life (HRQL) and symptom distress in patients with chronic HIV infection and plasma HIV RNA of less than 50 copies/ml. Prospective survey of adult patients (n = 46) enrolled in a randomized clinical trial evaluating intermittent versus continuous HAART on immunological and virologic parameters. Patients (n = 23) randomized to structured intermittent therapy received serial cycles of 4 weeks on/8 weeks off HAART. HRQL was measured by the physical and mental health summary scores of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Symptom distress was measured by the Symptom Distress Scale. Patients completed initial questionnaires prior to randomization and at weeks 4, 12, and 40 of the trial via a touch screen computer in an outpatient clinic. Baseline demographic and clinical characteristics were equivalent in both treatment groups. Although the mental health summary score declined significantly over time for the structured intermittent group, linear mixed modeling ANOVA indicated no significant difference across time for MOS-HIV summary and Symptom Distress Scale scores between the two treatment arms. In this small sample, repeated long-cycle structured intermittent therapy may not provide HRQL or symptom distress advantage compared to continuous HAART in patients with chronic HIV infection over 10 months of treatment. Further research in a heterogenous chronic HIV population and longer follow-up period is warranted.

Herbal medicine use and quality of life among people living with HIV/AIDS in northeastern Thailand

Many people living with HIV/AIDS (PHA) use herbal medicine as one of alternative therapies, where curative options are limited. This study aimed to examine the association between the herbal medicine use and quality of life (QOL) among PHA in northeastern Thailand. Participants were 132 HIV-positive Thai adults who attended the PHA's self-help group meetings from June to July 2002. Health-related QOL scores were measured by self-administered questionnaire from the Medical Outcomes Study-HIV Health Survey. Dimensions of physical function (PF) and mental health (MH) in QOL were assessed. Additional data were collected on herbal medicine use, socio-demographic, psychosocial and HIV-related characteristics. The herbal medicine users had significantly better MH scores than the non-users, while the herbal medicine use was not statistically associated with PF scores. When stratified, herbal medicine users with the following characteristics had significantly better MH scores than the non-users: female, widowed, having no income, reporting any HIV-related symptom, having no instrumental support or receiving subsidies. In conclusion, herbal medicine use was associated with better MH especially among socially vulnerable PHA. This study suggests that herbal medicine has a potential to improve the MH aspect of QOL among socially vulnerable PHA who cannot easily receive antiretroviral therapy in Thailand.

Measurement of Quality of Life in HIV Disease

Quality of life is an existential concept with multiple definitions. Clinicians and researchers are concerned with the more specific concept of health-related quality of life (HRQL), which considers the impact of impairments, functional states, perceptions, and social opportunities on overall quality of life. The unique nature of the issues related to living with HIV requires that the HRQL instruments used to evaluate HIV-infected patients include dimensions such as sexual function, stigma, and body image. HIV-specific instruments with established validity and reliability that have provided useful information in clinical trials include the Medical Outcomes Study-HIV Health Survey, HIV/AIDS--Targeted Quality of Life instrument, Functional Assessment of HIV Infection, AIDS Health Assessment Questionnaire, HIV Overview of Problems--Evaluation Systems, and Multidimensional Quality of Life Questionnaire for HIV/AIDS. As treatment advances, maximizing HRQL will become an increasingly important goal for clinicians involved in the care of HIV-infected individuals.

Health-Related Quality of Life in HIV Patients Switching to Twice-Daily Indinavir/Ritonavir Regimen or Continuing with Three-Times-Daily Indinavir-Based Therapy

To evaluate health-related quality of life (HRQoL) changes in patients treated with indinavir three-times daily after switching to a twice-daily indinavir/ritonavir regimen or continuing with the same regimen. Patients on HAART including indinavir three-times-daily with undetectable viral load were randomly assigned to continue with this therapy or to change to a twice-daily indinavir/ritonavir (800/100 mg) regimen. The Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire was used as the HRQoL measure. A total of 118 patients participated in the study, of which 59 (50%) were randomly assigned to continue with the three-times-daily regimen. Patients had a mean age of 39 years and 80% of them were male. At baseline, subjects included in the three-times-daily group presented a significantly greater number of symptoms than subjects in the twice-daily group, but no statistically significant differences were observed in MOS-HIV scores between the groups. In the intention-to-treat (ITT) analysis, a reduction in HRQoL scores was observed in both groups, which was greater in the twice-daily group. In the per protocol analysis, reduction of HRQoL was minimal. A HRQoL deterioration, greater in the twice-daily group, was observed in this study in the ITT analysis, while HRQoL remained stable in both groups in patients who continued with and tolerated the allocated regimen.

Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz

To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in 'health related quality of life' (HRQoL). A sub-study of the 2NN study, with antiretroviral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine. Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance. The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV (P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively (P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) > or = 100,000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event. First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.

Quality of life among people living with HIV/AIDS in northern Thailand: MOS-HIV Health Survey.

Translation and psychometric evaluation of a Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) in Thailand. A cross-sectional survey in Chiang Mai province, northern Thailand, with data collected in face-to-face interviews using a structured questionnaire designed to measure 10 scales of quality of life (QOL). We recruited 200 people with HIV/AIDS attending self-help groups in the municipal area. Standard guidelines were followed for questionnaire translation and psychometric evaluations. Item-level internal consistency and discriminant validity were reasonably established. Success rates were 93.8 and 97.4%, respectively. Scale-level internal consistency reliability of multi-item scales was satisfactory, ranging from 0.74 to 0.88, with all exceeding inter-scale correlations. Principal components analysis of item and scale scores identified two hypothesized dimensions of the MOS-HIV. The mental health component was strongly loaded by health distress, mental health, vitality and cognitive function scales, and physical health by role, physical and social functions, and pain scales. Respondents manifesting symptoms or reporting worsening health status scored significantly lower on all scales. These preliminary studies have shown the Thai version of the MOS-HIV to have psychometric properties comparable with those reported in previous surveys. Further testing and modification should make it useful as an HIV-specific QOL measure in Thailand.

The impact on health-related quality of life of treatment interruptions in HIV-1-infected patients.

To examine health-related quality of life (HRQOL) before, during and after treatment interruptions (TI) in antiretroviral therapy, we analysed results from Medical Outcomes Study HIV health surveys on 50 HIV-1-infected patients. HRQOL scores decreased during a TI but increased after re-initiating treatment, although scores remained lower than those preceding the TI. The reasons for a TI differentially affected HRQOL. The findings suggest that TI should be based on medical decisions and not used to increase HRQOL.

Validation of the Medical Outcomes Study HIV Health Survey as a measure of quality of life in HIV-infected patients in Singapore.

Measurement of quality of life is crucial to assess the full impact of antiretroviral therapy on patient morbidity. No quality of life instruments have been validated in an Asian HIV-infected patient population, but it is important to do so given the increasing involvement of the region in clinical trials. We set out to validate the Medical Outcomes Study HIV Health Survey (MOS-HIV) in HIV infected patients in Singapore. Clinically stable outpatients were asked to complete the 30-item MOS-HIV (English or Chinese translation). Patients were also asked about the frequency of selected disease symptoms, and clinical and demographic data were recorded from the case sheet. 163 patients (90% Chinese, 96% male, mean age 38 years, mean CD4 count 159 cells/mm(3)) participated in the study and completed the questionnaire to a satisfactory standard. The questionnaire showed good internal consistency (Cronbach's alpha >0.7 in all cases). There were significant differences in quality of life scores between Centers for Disease Control disease stages, and significant correlations with CD4 count and symptom score, confirming the discriminant validity of the MOS-HIV. Factor analysis revealed two components corresponding to physical and mental health which were similar to those of studies in Western countries except that pain was more closely related to mental than physical health. Linear regression analysis identified symptom burden as the major predictor of physical and mental health. We concluded that the MOS-HIV is a valid measure of quality of life in this HIV patient population in Singapore, and is therefore likely to be useful in future clinical trials in the region. In the era of chronic HIV disease, close attention to symptoms (disease or drug-related) is warranted due to their major adverse influence on mental and physical aspects of quality of life.

Effectiveness of a Home-Based Exercise Intervention For HIV-Infected Adults: A Randomized Trial

The authors conducted a randomized controlled trial to assess the impact of a 15-week (20 minutes three times per week) home-based aerobic exercise intervention versus usual care on the physical endurance, immune status, and self-reported health status of 99 HIV-infected adults. In the exercise group, there was no improvement in physical endurance or health-related quality of life (HRQOL), except in the Medical Outcomes Study-HIV Health Survey Overall Health subscale (difference = 12.1, 95% confidence interval = 2.0-22.2, p = .02). Although physical endurance levels were maintained at baseline levels in the intervention group and declined in the control group, differences between the groups were small and not significant. There were also no significant changes in CD4+ T-lymphocyte counts. Exercise appears to be safe in HIV-infected patients. Improvements in physical endurance and HRQOL might result if the exercise protocol is longer or progressive. Further research is needed to establish guidelines for exercise in patients on highly active antiretroviral therapy.