Medical Outcomes Study HIV Health Research Articles

Health-related quality of life and associated factors among people living with HIV/AIDS in Lagos, Nigeria.

Although people living with HIV (PLWH) now have a longer life expectancy due to antiretroviral therapy, several factors impact their health-related quality of life (HRQoL). Understanding the dimensions and determinants of HRQoL among PLWH is crucial to developing solutions to improve their overall wellbeing. This research aimed to explore the HRQoL and its associated factors among PLWH in Lagos, Nigeria. Seven HIV testing and treatment centres in Lagos. A cross-sectional survey was conducted with 385 participants. Socio-demographic and HRQoL data were obtained using questionnaires and the Medical Outcomes Study HIV Health Survey (MOS-HIV). Logistic regression models were used to identify variables that were associated with quality of life. The physical health summary and mental health summary scores measured by the MOS-HIV were 54.2 ± 5.3 and 56.3 ± 6.7, respectively. Being married, having higher levels of education, shorter duration of HIV and higher income levels were significantly associated with better HRQoL. The duration of HIV was found to have an inversely proportional influence on the quality of life of PLWH, both in physical health (χ2= 9.477,p= 0.009) and mental health (χ2= 11.88,p= 0.004) dimensions. The HRQoL of PLWH in Lagos, Nigeria was relatively low. Education, duration of HIV, marital status and income level are predictors of HRQoL.Contribution:This study is valuable for healthcare professionals and policymakers, providing them with essential information to tailor interventions and allocate resources effectively to improve the overall wellbeing of PLWH in Nigeria.

Health-related quality of life and associated factors among people living with HIV/AIDS in Sichuan, China: A cross-sectional study.

This study aimed to explore health-related quality of life (HRQoL) and its associated factors among people living with HIV/AIDS (PLWH) in Sichuan, China. A total of 401 PLWH were recruited from the city of Panzhihua between August 2018 and January 2019. Demographic characteristics and disease-related data were collected by self-administered questionnaires and medical system records. Health-related quality of life (HRQoL) was measured by the medical outcome study HIV health survey (MOS-HIV), which measured ten subdimensions and two summarized dimensions, the physical health summary score (PHS) and the mental health summary score (MHS). Logistic regression models were used to explore the variables independently associated with quality of life. The PHS and MHS measured by MOS-HIV were 53.66 ± 6.80 and 51.31 ± 7.66, respectively. Younger age, higher educational level, no methadone use, higher CD4 lymphocyte counts, less symptom counts and heathy BMI significantly were associated with higher HRQOL in the univariate χ2-test analysis. Education level was found to have a significant influence on patients' quality of life, both in physical health (P = 0.022) and mental health (P = 0.002) dimensions. Younger age (P = 0.032), higher CD4 lymphocyte counts (P = 0.007), less symptom counts (P < 0.001) and health BMI level (P < 0.001) were positively related to the PHS of quality of life in the multivariable logistic regression model. The HRQoL of PLWH in Sinchuan Province was relatively low. Age, educational level, methadone use, CD4 lymphocyte counts, symptom counts and BMI were positively related to quality of life. This study indicates that health caregivers should pay more attention to comorbidity issues and mental health in PLWH, especially for those with lower education levels, unhealthy body mass index, more symptomatic presentation and older age.

Adherence to anti-retroviral therapy, decisional conflicts, and health-related quality of life among treatment-naïve individuals living with HIV: a DEARS-J observational study

BackgroundSupporting people living with HIV using anti-retroviral therapy (ART) is important due to the requirement for strict medication adherence. To date, no data from longitudinal studies evaluating adherence by treatment-naïve people living with HIV are currently available. We investigated the adherence of treatment-naïve people living with HIV over time and examined the relationships among decisional conflicts, adherence, and health-related quality of life (HRQL).MethodsThe survey items included adherence (visual analogue scale [VAS]), decisional conflict (decisional conflict scale [DCS]), and HRQL (Medical Outcomes Study HIV Health Survey [MOS-HIV]). The DCS and MOS-HIV scores and the VAS and MOS scores were collected electronically at the ART initiation time point and at 4-, 24-, and 48-week post-treatment time points.ResultsA total of 215 participants were enrolled. The mean DCS score was 27.3 (SD, 0.9); 23.3% of participants were in the high-score and 36.7% in the low-score groups. The mean adherence rates at 4, 24, and 48 weeks were 99.2% (standard error [SE], 0.2), 98.4% (SE, 0.4), and 96.0% (SE, 1.2), respectively. The least-square means of the MOS-HIV for the DCS (high vs. low scores) were 64.4 vs. 69.2 for general health perceptions and 57.7 vs. 64.0 for HRQL, respectively.ConclusionAdherence among treatment-naïve people living with HIV was maintained at a higher level, and HRQL tended to improve with ART. People with high levels of decisional conflict tended to have lower HRQL scores. Support for people living with HIV during ART initiation may be related to HRQL.

Cardiometabolic Diseases and Quality-of-Life Outcomes in Adults With HIV in the Deep South: A Cross-sectional Study.

The role of cardiometabolic diseases (CMDs) on physical health-related quality of life (P-HRQoL) and quality of sleep was examined among 261 PLWH ≥40 years, recruited from a university-affiliated HIV clinic in the Deep U.S. South. Using a cross-sectional study design, participants completed the Medical Outcomes Study HIV Health Survey (MOS-HIV; P-HRQoL) and Pittsburgh Sleep Quality Index. The overall prevalence of self-reporting ≥1 CMD was 64.4%. P-HRQoL scores were lower in PLWH with ≥1 CMD compared with those with no CMDs (45.53 ± 11.54 vs. 49.67 ± 10.77, p <.01). Poor sleep quality was higher among participants with ≥1 CMD compared with those with no CMDs (9.28 ± 4.42 vs. 7.26 ± 4.17, p <.01). Each additional CMD resulted in a 1.83-point decrease in P-HRQoL and 0.74-point increase in poor sleep quality scores. Interventions that focus on targeting these quality-of-life domains in PLWH with CMDs are needed.

Predictors of Stigma and Health-Related Quality of Life Among People Living with HIV in Northern Thailand

HIV-related stigma and discrimination have been a significant barrier to accessing health care, hence contributing to poor health outcomes. This study aimed to investigate factors associated with HIV-related stigma and discrimination and health-related quality of life (HRQoL) among people living with HIV in rural Thailand setting. A cross-sectional convenience sample of 161 HIV-positive Thai patients was recruited from a single rural district hospital using a self-administered questionnaire entailing sociodemographic information, the 12-item stigma scale, the Medical Outcomes Study HIV Health Survey (MOS-HIV), and the EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Linear regression and the multi-variable analyses were used to investigate factors associated with stigma and HRQoL, whereas the correlations between stigma and quality of life variables were tested by Pearson correlations. Being married and duration of antiretroviral therapy were negatively correlated with HIV stigma, while increased age was inversely associated with HRQoL. Being employed and having sufficient money for living contributed positively to predict HRQoL. HIV stigma was negatively associated with mental health summary (MHS) and visual analog scale (VAS) score, whereas duration diagnosed with HIV and the use of two nucleoside reverse transcriptase inhibitors in combination with protease inhibitor regimen were negative factors associated with VAS and health utility, respectively. The findings confirm complex and inseparable associations of factors relating to HIV-related stigma and HRQoL. The development of effective interventions tailored at individual level is warranted to address this gap.

Abstract EP08: Cardiometabolic Diseases, Quality Of Life And Sleep In Adults With Hiv In The Deep South

Introduction: Cardiometabolic diseases (CMDs) are prevalent among middle-aged and older people living with HIV (OPLWH), particularly in the Deep South. However, the role CMDs play on quality-of-life outcomes among OPLWH remain understudied. Purpose: The purpose of this observational study was to examine the association between CMDs and physical health-related quality of life (P-HRQOL) and quality of sleep among PLWH in the Deep South. Methods: This cross-sectional study included N=261 HIV-infected participants aged 40+ recruited from a University HIV/AIDS clinic located in the Southeastern United States. CMDs were self-reported and consisted of hypertension, heart failure, stroke, diabetes mellitus, Angina due to heart disease, and high cholesterol. P-HRQOL and sleep quality scores were obtained using the Medical Outcome Study HIV Health Survey (MOS-HIV) and Pittsburgh sleep quality index (PSQI). We performed regression analyses (adjusting for demographic confounders and depression) for each outcome to assess the association between CMDs and P-HRQOL and sleep quality among OPLWH. Results: The average age of participants was 51.10 ± 6.78, with 82.8% being non-white and 35.6% being males. The overall prevalence of having ≥ 1CMD was 64.4% (High cholesterol: 52.8%; Diabetes Mellitus: 22.8%; Stroke: 5.68%; Angina/chest pain: 4.5%; Heart Failure: 6.8%; Hypertension 84%). P-HRQOL scores were significantly lower in PLWH with ≥1 CMD compared to the non-CMD group (45.53 ± 11.54 Vs. 49.67 ± 10.77, p&lt;0.01). PSQI sleep disturbance scores were significantly higher among participants with ≥1CMD compared to the non-CMD group (9.28 ± 4.42 vs. 7.26 ± 4.17, p&lt;0.01). In the covariate adjusted regression analysis, each additional CMD resulted in a 1.83 decrease in P-HRQOL while PSQI sleep disturbance increased by 0.74. Conclusion: In a sample of PLWH in the Deep South, the presence of CMDs increased the risk for poor P-HRQOL and greater sleep disturbances. Interventions that focus on targeting P-HRQOL and sleep quality in OPLWH with CMDs are necessary to improve long-term outcomes.

Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya.

Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n=716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P<0.001) and 2.92 times greater odds of probable depression (P<0.001). Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.

Health-related quality of life and associated factors among people living with human immunodeficiency virus on highly active antiretroviral therapy in North East Ethiopia: Cross-sectional study.

IntroductionHIV/AIDS remains a public health concern affecting millions of people across the world. Although the health-related quality of life (HRQoL) of patients living with HIV has significantly improved after treatment, its chronicity makes the HRQoL uncertain. This study assessed factors associated with the health-related quality of life among people living with HIV/AIDS on HAART in North-East Ethiopia.MethodsAn institutional-based cross-sectional study was conducted from March to April 2018, and systematic random sampling was used to select 235 participants who were on HAART. HRQoL was assessed using the Medical Outcomes Study HIV Health Survey. Descriptive and multiple linear regression analysis were computed using the statistical package for social sciences version 20.ResultsThe study revealed one-factor structure and had good overall internal consistency (78.5). Over one-third (42.6%; 95% CI; 36.2%, 48.9%) of participants had good HRQoL. The least HRQoL mean score was found for cognitive functioning 32.21(±19.78), followed by social functioning 40.58(±29.8). Factors associated with the overall HRQoL were 25–45 years of age (β = − 3.55, 95% CI;-6.54, -0.55), working in private sector (β = -5.66, 95% CI;-9.43, -1.88), government (β = -4.29, 95% CI;-7.83, -0.75) and self-employment (β = -8.86, 95% CI;-13.50, -4.21), 100–200 (β = − 4.84, 95% CI;-9.04, -0.63) and 201–350 CD4 at the time of diagnosis (β = − 7.45, 95% CI;-11.73, -3.16), 351–500 current CD4 level (β = 8.34, 95% CI;5.55, 11.41), 6–10 years of disease duration (β = -8.28, 95% CI;-12.51, -4.04), WHO stage II (β = -4.78, 95% CI;-8.52, -1.04) and III (β = 3.42, 95% CI;0.06, 6.79) during treatment initiation and not taking of Cotrimoxazole prophylaxis (β = -5.79, 95% CI;-8.34, -3.25).ConclusionsHigh proportion of participants had a poor HRQoL. Routine assessment and appropriate interventions at each visit is recommended to improve HRQoL.

A-077 Relationship Between Mental Health and Physical Health and Neurocognitive Function among Latinx People Living With HIV

Abstract Objective The relationship between self-reported mental health (MH), physical health (PH), and neurocognition (NC) is vastly understudied among Latinx people living with HIV (PLWH). Evidence of increased somatization in this group suggests that self-reported MH and PH may contextualize cognitive outcomes among Latinx PLWH. Thus, this study examines the relationship between self-reported MH/PH and NC in a sample of Latinx PLWH. Method This study included 76 Latinx PLWH (33% female; M age = 46.0, SD = 7.08) who completed the Medical Outcomes Study HIV Health Survey (MOS-HIV) and a comprehensive neurocognitive battery. MH and PH were defined by the MOS-HIV, where higher MH and PH summary scores indicate better perceived health. Demographically-corrected T-scores were used to compute average global NC and domain scores. Results Within Latinx PLWH, partial correlations controlling for age and education found PH was associated with better processing speed (r = .28, p = .03), and MH was related to better global NC, fluency, learning, and processing speed (ps &amp;lt; .05). A series of multiple regressions (Step 1: age, education, Step 2: MH, PH summary scores) were used to predict NC domain scores. MH (R2 = .11–.15) significantly predicted better attention/working memory (β = .26, p = .03) and global NC at the trend level (β = .19, p = .07). PH did not predict any NC domains. Conclusions Findings indicate that MH and PH correlated with global and domain-specific NC within Latinx PLWH. Better self-reported MH may improve attention/working memory and global NC in Latinx PLWH. Somatization is important when considering MH/PH and cognition within Latinx PLWH; physicians should consider the impact of patients’ self-reported MH/PH on NC in Latinx PLWH.

Perceived social support, depression and their impact on quality of life of people living with HIV in India

ABSTRACT Universal access to Antiretroviral Treatment (ART) has transformed HIV/AIDS into a chronic disease and issues like social support and Quality of life (QOL) have emerged as important components of care. Perceived social support influences QOL in People Living with HIV (PLHIV), though this has not been studied well in India. PLHIV were assessed for Social Support using the Multidimensional Scale of Perceived Social Support (MSPSS) and QOL was assessed with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. The factors impacting social support and its effect of on QOL were analysed. Amongst the 109 study subjects, 62 (56.9%) were men, 47 (43.1%) were women, mean age was 35 ± 7.5 years, 85.3% had WHO stage 1 disease and 80 (73.4%) were receiving ART. Only 43.1% subjects perceived high overall social support. Social support (from family/friends/others) was associated positively with physical functioning (p = 0.001), social and cognitive functioning (p = 0.000) and significantly inversely associated with depression (p = 0.002). Higher perceived social support was seen to correlate with higher CD4 count (Peak, Nadir and Current; p < 0.05) and better adherence (p = 0.003). It is concluded that social support, including support from beyond family, have a significant impact on clinical endpoints and QOL in PLHIV.

Quality of life and its determinants among people living with HIV attending an antiretroviral treatment center in Delhi, India.

With universal access to antiretroviral treatment (ART), the management of people living with human immunodeficiency virus (PLHIV) encompasses holistic, comprehensive care. Despite being a vital goal of care, quality of life (QOL) assessment of PLHIV in India is neglected. This study assessed the QOL and its determinants among PLHIV accessing services through ART centers. The cross-sectional study was conducted from November 2015 to February 2017 among 109 PLHIV attending an ART center in New Delhi. Sociodemographic and clinical profile characteristics were ascertained. QoL was evaluated using the medical outcomes study HIV health survey questionnaire; physical health summary (PHS), and mental health summary (MHS) scores were calculated. Depression was evaluated with the becks depression inventory and social support using the multidimensional scale of perceived social support. Chi-square test, Student's t-test, and analysis of variance were used as test of significance. The overall QOL was: PHS-48.04 ± 8.27 and MHS 42.43 ± 8.79. PHS scores were significantly higher among PLHIV with older age (P = 0.04), higher formal education (P = 0.022), early HIV disease (P = 0.006), higher CD4 counts (current, peak and nadir: P =0.024, 0.008, and ≤0.001, respectively), receiving ART (P = 0.05), with better social support (P = 0.012) and without depression (P ≤ 0.001). Similarly, MHS scores were better in PLHIV with greater formal education (P = 0.009), early HIV disease (P = 0.046), without depression (P ≤ 0.001). Depression and social support mechanisms emerged as two key determinants of QOL. Older age, higher education, less advanced disease, and ART were predictive of better QOL.

FUNCTIONAL WELLNESS AND OLDER MEN WITH HIV

Aging-related stressors, such as changing physical function, poorly managed multimorbidity, increasing pill burden and social losses can diminish for some older adults with HIV the capacity for self-care. These challenges, however, can be improved by maintaining physical, cognitive and social function, or functional wellness. Using cross-sectional data from a men’s health study with younger and older men with and without HIV, we conducted general linear models to identify individual and clinical predictors for physical, cognitive, social and role function, as measured by the Medical Outcomes Study HIV Health Survey. We found that older HIV+ men had lower burdens of functional deficits compared to older HIV- men and younger HIV+ men and that across all models, depression, followed by diabetes, housing, and employment were predictive of functional wellness. Functional wellness for older HIV+ men is a multidimensional construct that includes optimizing internal and external resources to maintain healthy living and wellness.

Effect of chronic disease self-management program on the quality of life of HIV-infected men who have sex with men: An empirical study in Shanghai, China.

The HIV/AIDS epidemic rages on in China, particularly among men who have sex with men (MSM). MSM with HIV/AIDS also tend to have poorer quality of life than other members of the population. A major contributor to these issues is the huge gap between the increasing demand of MSM for medical services and the availability of such services; their current needs cannot be met only with the services of the Chinese Center for Disease Control and Prevention. The aim of the present study was to examine the quality of life of MSM with HIV/AIDS in Shanghai, as well as determine whether it is influenced by chronic disease self-management (CDSM). We conducted a pre-post study to evaluate the effect of CDSM on participants' quality of life. Four hundred twenty participants were assigned to either the CDSM group (n = 210) or the control group (n = 210). We collected data on quality of life (using the Medical Outcomes Study HIV Health Survey [MOS-HIV]) and various psychological and behavioral variables via interviewer-administered questionnaires. The physical and mental health summary scores of the MOS-HIV were 53.7 and 49.9, respectively. The CDSM group showed a significant improvement in quality of life and a significant decrease in the proportion of participants with anxiety symptoms (from 38.6% to 22.6%). Furthermore, the frequency of condom use increased from 43.3% to 47.3%. MSM with HIV generally had low quality of life in Shanghai. The CDSM program might help promote the quality of life of MSM while helping them practice healthy behaviors.

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3\u2009L) utility index

BackgroundMapping of health-related quality-of-life measures to health utility values can facilitate cost-utility evaluation. Regression-based methods tend to lead to shrinkage of variance. This study aims to map the Medical Outcomes Study HIV Health Survey (MOS-HIV) to EuroQoL 5 Dimensions (EQ-5D-3 L) utility index, and to characterize the performance of three mapping methods, including ordinary least squares (OLS), equi-percentile method (EPM), and a recently proposed method called Mean Rank Method (MRM).MethodsThis is a secondary analysis of data from a randomized HIV treatment trial. Baseline data from 421 participants were used to develop mapping functions. Follow-up data from 236 participants was used to validate the mapping functions.ResultsIn the training dataset, MRM and OLS, but not EPM, reproduced the observed mean utility (0.731). MRM, OLS and EPM under-estimated the standard deviation by 0.3, 26.6 and 1.7%, respectively. MRM had the lowest mean absolute error (0.143) and highest intraclass correlation coefficient (0.723) with the observed utility values, whereas OLS had the lowest mean squared error (0.038) and highest R-squared (0.542). Regressing the MRM- and OLS-mapped utility values upon body mass index and log-viral load gave covariate associations comparable to those estimated from the observed utility data (all P > 0.10). EPM did not achieve this property. Findings from the validation data were similar.ConclusionsFunctions are available for mapping the MOS-HIV to the EQ-5D-3 L utility values. MRM and OLS were comparable in terms of agreement with the observed utility values at the individual level. MRM had better performance at the group level in terms of describing the utility distribution.Trial registrationNCT00988039. Registered 30 September 2009.

Social Capital Associated with Quality of Life among People Living with HIV/AIDS in Nanchang, China.

Background: This study aims to explore the relationship between quality of life (QOL) and social capital factors among “people living with HIV/AIDS” (PLWHA), in order to improve their quality of life and help them to release AIDS discrimination. Methods: A cross-sectional survey with 225 PLWHA was done in Nanchang, China, between January and June of 2015. Questionnaires consisted of a socio-demographic questionnaire, Personal Social Capital Scale and Medical Outcomes Study HIV Health Survey. To identify social capital factors influencing QOL among PLWHA, t-test and multiple linear regression were used as statistical tools. The analysis of data was conducted using SPSS 22.0 with a significant value of p < 0.05. Results: The scores of total social capital, bonding social capital and bridging social capital were 23.68 ± 5.55, 14.11 ± 3.40 and 9.46 ± 3.43 respectively. The scores of Physical Health Summary (PHS) and Mental Health Summary (MHS) were 51.88 ± 7.04 and 49.29 ± 6.60. Multiple linear regression analysis showed that age (B = −0.137, p = 0.020), income (B = 0.2170, p ≤ 0.001), employment (B = 0.112, p = 0.043) and bonding social capital (B = 0.178, p = 0.001) had significant effects on PHS. Bonding social capital was the most important influencing factor for MHS (B = 0.506, p < 0.001). There was no significant relationship between bridging social capital and QOL (p > 0.05). Conclusions: The PLWHA community has low social capital and a poor QOL in Nanchang. Bonding social capital had a positive impact on the QOL of PLWHA. There is an urgent need to build a better social support system based on bonding social capital for PLWHA. It is worth further exploring to identify how to make full use of bridging social capital for improving QOL among PLWHA.

Facial biostimulation with PRP activated with ozone resound on cellular redox balance, improves lipoatrophy and quality of life in HIV patients

Context: Pathogenic impact of high-grade local and systemic oxidative stress in antiretroviral treated HIV patients are recognized factor influencing in lipodystrophy, which is proposed can be ameliorate with platelet rich plasma (PRP). Aims: To determine the efficacy and safety of ozone and calcium activated PRP application in lipoatrophy- AIDS Cuban individuals. Methods: Thirty HIV individuals enrolled in quasi experimental prospective study showed lipoatrophy grade from 1 to 3. A mean volume interval of 8 to 22.2 mL of PRP was injected in 5 interventions during a year. The clinical, chemical, oxidative stress and progression indexes determinations were performed prior to injections and at 6 and 12 months after. Also, questionnaires based on Short Form 36, Medical Outcomes Study HIV Health Survey were assessed. Different statistical analyses were done comparing baseline respect final values of variables. Results: Beneficial improve of lipoatrophy grade (p&lt;0.05) and stabilization in global indexes of damage and antioxidant status at the end of the study was demonstrated. The comparison revealed a significantly smaller damage and higher antioxidant status compared to baseline values (p&lt;0.05). Non-significant modifications were observed in hematological and chemical indexes (p˃0.05), respect quality of life 75% of three dimensions improved and depressive symptoms decreased. Non-adverse reactions were observed during the study period. Conclusions: These results corroborate that beneficial amelioration of oxidative stress occurs in lipoatrophy AIDS patients during effective and safety PRP-ozone facial bioestimulation. Integral diagnosis would be worthwhile to conduct a more comprehensive study and manage of lipoatrophy.

Comparison of Zidovudine and Tenofovir Based Regimens With Regard to Health-Related Quality of Life and Prevalence of Symptoms in HIV Patients in a Kenyan Referral Hospital

Aim: Zidovudine and tenofovir form the backbone of antiretroviral therapy in Kenya. However, their side-effects may affect the quality of life (QoL) of patients. The aim was to compare the health-related quality of life (HRQoL) of adult patients on tenofovir versus zidovudine based regimens in a referral hospital in Kenya to provide future guidance.Methods: A comparative cross sectional study among 501 adult out-patients on either tenofovir or zidovudine was undertaken in Kenyatta National Hospital between 2015 and 2016. The Medical Outcome Study HIV Health Survey (MOS-HIV) was administered along with other key aspects of treatment. Linear regression analysis was performed to identify determinants of HRQoL.Results: Patients on zidovudine had a higher Physical Health Summary Score (PHSS) and Mental Health Summary Score (MHSS) compared to those on tenofovir. The presence of any symptom of the disease and a stated inability to cope were negatively associated with PHSS, whilst having a regular source of income improved PHSS. Being on tenofovir, symptom of illness [β = -1.24; 95% CI (-2.253, -0.226)], absence of pain [β=0.413; 95% CI (0.152, 0.674)] and patient stated inability to cope with HIV [β = -1.029; 95% CI (-1.441, -0.617)] affected the MHSS. Patients on tenofovir and second line regimens had more signs and symptoms of illness.Conclusion: Participants on zidovudine based regimens showed a better performance across all aspects of HRQoL. These are considerations for the future.

Changes and determinants of health-related quality of life among people newly diagnosed with HIV in China: a 1-year follow-up study

PurposeThis study aimed to investigate changes in health-related quality of life (HRQoL) among people newly diagnosed with HIV and to identify factors associated with HRQoL.MethodsNewly diagnosed HIV-positive individuals were consecutively recruited and assessed at baseline and 1-year follow-up after diagnosis. HRQoL was measured through the physical health summary score (PHS) and mental health summary score (MHS) derived from the Medical Outcomes Study HIV Health Survey. Socio-demographic, clinical, and psychological information was also collected at both times. Generalized estimating equations were applied to explore factors associated with HRQoL in 1 year.ResultsA total of 410 participants were included. After 1 year, significant increases were observed for both the mean PHS score (53.5–55.0; p = 0.009) and the mean MHS score (44.2–49.0; p < 0.001). Older age (p = 0.024), rural household registration (p = 0.031), HIV-related symptoms (p < 0.001), and depression (p = 0.014) were negatively associated with PHS. Additionally, the negative association between stress and PHS increased over time (β = − 0.07 for the baseline; β = − 0.18 for the 12-month follow-up; p < 0.001). HIV-related symptoms, depression, lower social support, and higher levels of stress (all p < 0.001) were negatively associated with MHS. Additionally, the negative relationship between stress and MHS was stronger among participants who were asymptomatic (p = 0.015).ConclusionA relatively lower HRQoL among HIV-infected people shortly after HIV diagnosis and an increase in HRQoL among people 1 year after HIV diagnosis were observed. Additional attention should be paid to individuals of older age, from rural areas, with HIV-related symptoms, with depression, with high levels of stress, and with a lack of social support.

Reliability and validity of the Chinese version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) in people living with HIV/AIDS (PLWHA) in China.

ObjectiveThe aim of the study was to assess the psychometric properties of the Medical Outcomes Study HIV Health Survey (MOS-HIV) in people living with HIV/AIDS (PLWHA) in mainland China.MethodsA cross-sectional survey was conducted in 646 PLWHA between May 2015 and March 2016 in Dalian, Ningbo, and Zhengzhou City, China. The MOS-HIV includes 35 items and measures 10 scales. These ten scales can be effectively calculated under two summary scale scores, the physical health score (PHS) and the mental health score (MHS), with the physical functioning, pain and role functioning scales contributing to the PHS, the mental health, health distress, quality of life and cognitive function scales contributing to the MHS, and the energy/fatigue, general health and social functioning contributing to both factors. Reliability was measured in terms of internal consistency and test-retest reliability. The internal consistency of the questionnaire was analyzed using Cronbach’s α coefficient, and test-retest reliability was assessed using Pearson’s correlation coefficient. Validity was analyzed via construct validity, convergent and discriminant validity, and known group validity. Confirmatory factor analyses (CFA) were used to test construct validity. A multiple-group CFA analysis was conducted to investigate whether the MOS-HIV measured the same constructs across gender groups.ResultsThe MOS-HIV questionnaire was reliable and valid. Reliability of the PHS and MHS scales was 0.87 and 0.89, respectively. While the Cronbach’s α coefficients for each of the dimensions were > 0.70. According to the results of the confirmatory factor analysis (CFA), the hypothesized model was acceptable. The instrument showed factorial invariance across gender groups. All correlation coefficients were greater than 0.40, with a range of 0.60–0.94. The correlation coefficients observed between items and other dimensions were lower than the coefficients for the correlations between items and hypothesized dimensions for all scales, suggesting good convergent and discriminant validity. Patients with CD4 counts >500 cells/mm3 demonstrated better QOL than those with lower CD4 counts on six scales and the PHS (p<0.05) and symptomatic respondents had significantly lower scores than asymptomatic respondents on all the scales except health transition scales (p<0.05) suggesting good known group validity.ConclusionsThe results of this study provide evidence that the MOS-HIV may be an acceptable, valid and reliable instrument for evaluating QOL of PLWHA in mainland China.

Mapping MOS-HIV to HUI3 and EQ-5D-3L in Patients With HIV.

Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV) is frequently used in HIV clinical trials; however, scores generated from the MOS-HIV are not suited for cost-effectiveness analyses as they do not assign utility values to health states. Our objective was to estimate and externally validate several mapping algorithms to predict Health Utilities Index Mark 3 (HUI3) and EQ-5D-3L utility values from the MOS-HIV. Methods: We developed and validated mapping algorithms using data from two HIV clinical trials. Data from the first trial (n = 367) formed the estimation data set for the HUI3 (4,610 observations) and EQ-5D-3L (4,662 observations) mapping algorithms; data from the second trial (n = 168) formed the HUI3 (1,135 observations) and EQ-5D-3L (1,152 observations) external validation data set. We compared ordinary least squares (OLS) models of increasing complexity with the more flexible two-part, beta regression, and finite mixture models. We assessed model performance using mean absolute error (MAE) and mean squared error (MSE). Results: The OLS model that used MOS-HIV dimension scores along with squared terms gave the best HUI3 predictions (mean observed 0.84; mean predicted 0.80; MAE 0.0961); the finite mixture model gave the best EQ-5D-3L predictions (mean observed 0.90; mean predicted 0.88; MAE 0.0567). All models produced higher prediction errors at the lower end of the HUI3 and EQ-5D-3L score ranges (<0.40). Conclusions: The proposed mapping algorithms can be used to predict HUI3 and EQ-5D-3L utility values from the MOS-HIV, although greater error may pose a problem in samples where a substantial proportion of patients are in poor health. These algorithms may be useful for estimating utility values from the MOS-HIV for cost-effectiveness studies when HUI3 or EQ-5D-3L data are not available.