Quality Of Life For People Living With HIV Research Articles

Effect of Supportive Care on Quality of Life for People Living with Human Immunodeficiency Virus: A Systematic Review

The survival of people living with HIV (PLWH) affects physical, psychological, sexual, social, and financial circumstances during the care and treatment phase. Supportive care is an effective intervention associated with a better quality of life. The aim of this systematic study was to identify effect supportive care intervention on quality-of-life infected people. This study was a systematic review to examine the effect of supportive care in PLWH. Four databases including Science Direct, ProQuest, PubMed, and Wiley library were included to identify the relevant articles. A total of eight articles out of the 247 publications potentially met the inclusion criteria. Supportive care was grouped into four categories, including Community Based Intervention, M-Health Intervention, Social Media-Based Interventions as well as Psychosocial Interventions. The combination of all interventions showed that supportive care needs to be prescribed in line with the conditions and needs of PLWH. Conclusion, several supportive care approaches including Group Support Psychotherapy (GSP), Peer Support (PS), Run4Love WeChat, ALWH treatment strategy, effective communication, and psychosocial assessment, Mental health care pathway PASEO and combination logotherapy, ACT, as well as family psychoeducation (FPE) affected the quality of life for PLWH. This helped in characterizing the intervention and its effect on the conditions of HIV patients.Keywords: Databases; Supportive care; Psychosocial interventions; Quality of life

Accelerated Aging process in Patients Living with HIV: Role of Mitochondrial Dysfunction.

Introduction Despite the success of antiretroviral therapy (ART) in making HIV a chronic condition, People living with HIV (PLWH) experience an increased prevalence of age-related diseases earlier than HIV-negative individuals. These conditions span cardiovascular, metabolic, and neurologic illnesses, suggesting an advanced aging process influenced by chronic inflammation, known as “Inflammaging.” HIV-associated-mitochondrial dysfunction (HIVAMD) is proposed as a significant factor driving this accelerated aging, linked to chronic low-grade inflammation, immune activation, and the side effects of ART. Methods The review delves into the mechanics of mitochondrial dysfunction, highlighting how HIV infection and ART disrupt mitochondrial bioenergetics, leading to oxidative stress and cellular damage. Additionally, the document explores the roles of HIV proteins and ART in exacerbating mitochondrial dysfunction, alongside the effects of CD38 overactivation and IDO-1 pathways, which further deplete NAD+ levels and impair cellular metabolism. Results The analysis underscores the pivotal role of mitochondrial dysfunction in driving accelerated aging in PLWH, highlighting its association with chronic inflammation, immune dysregulation, and ART-related effects. By elucidating the mechanisms underlying HIVAMD, the review emphasizes the importance of targeting mitochondrial dysfunction and associated metabolic pathways as therapeutic strategies to mitigate accelerated aging in PLWH. Conclusion The review advocates for future research endeavors aimed at exploring interventions that could reverse or ameliorate HIVAMD, employing a geroscience-guided approach to enhance the healthspan and quality of life for PLWH. It underscores the need for comprehensive strategies combining pharmacological and non-pharmacological interventions to address the complex interplay between HIV, its treatment, and aging processes.

Bone Disease in HIV: Need for Early Diagnosis and Prevention.

The transformation of HIV into a manageable chronic condition has unveiled new clinical challenges associated with aging-related pathologies, including bone disease. This review explores the intricate relationship between HIV, antiretroviral therapy (ART), and bone disease, highlighting the necessity of early diagnosis and preventative strategies to mitigate the increased risk of osteopenia, osteoporosis, and fractures in people living with HIV (PLWHIV). It synthesizes the current literature to elucidate the multifactorial etiology of bone pathology in this population, that includes direct viral effects, chronic immune activation, ART-associated risks, and the impact of traditional risk factors for bone loss. Through a critical examination of modern diagnostic methods, lifestyle modifications, evidence-based preventive actions, and pharmacological treatments, the necessity for comprehensive management is highlighted, along with recommendations for integrated healthcare approaches vital for achieving optimal patient outcomes. By advocating for a proactive, patient-centered, and multidisciplinary strategy, this review proposes a plan to integrate bone health into standard HIV care through active risk identification, vigilant screening, effective preventive measures, tailored treatments, and informed decision-making, in an effort to ultimately enhance the quality of life for PLWHIV.

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.

Psychometric and Circumplex Properties Evaluation of the International Personality Item Pool-Interpersonal Circumplex (IPIP-IPC) in Chinese People Living with HIV (PLWH).

With the improved life expectancy of people living with HIV (PLWH) due to widespread use of antiretroviral therapy (ART), there is a greater emphasis on enhancing long-term well-being and overall quality of life for PLWH. Understanding interpersonal personalities of PLWH can gain further insight into how to improve the overall quality of life in this population. The International Personality Item Pool-Interpersonal Circumplex (IPIP-IPC) scale has been developed to assess interpersonal personalities of individuals, and this scale has been translated into Chinese. However, the Chinese version of IPIP-IPC has not been tested among PLWH in China. In this study, we aimed to test the psychometric properties and circumplex structure of this scale. This study was based on cross-sectional, multi-center, large sample data. We employed the Chinese version of IPIP-IPC scale on 3040 PLWH from April 2022 to April 2023 in China to test its psychometric as well as circumplex properties. The structural summary method (SSM) was employed to analyze the circumplex structure of the scale. The total scale exhibited a Cronbach's alpha of 0.85 and McDonald's omega of 0.91. Out of the 288 possible relationships, 275 relationships satisfy the circular properties hypothesis. The scale demonstrates good reliability and validity, meeting the requirements of psychometrics. Our findings demonstrate that the Chinese version of the IPIP-IPC scale is a reliable tool for evaluating interpersonal personalities in this population. These results highlight the validity and applicability of the IPIP-IPC scale specifically in the Chinese context, providing valuable insights into the intricacies of interpersonal traits among 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.

Development of a spiritual-based palliative care model for the quality of life of people with HIV/AIDS

People living with HIV (PLHIV) require a focus on their quality of life to prevent deterioration. This study aims to establish a spiritual-based palliative nursing model to enhance the quality of life for PLHIV. A cross-sectional study of 225 PLHIV receiving treatment at Said Sukanto Hospital, Jakarta. Data, including demographic, disease, psychological, spiritual, support, services, spiritual-based palliative care, spiritual meaning in illness experience, and quality of life variables, were collected using a researcher-modified questionnaire. Data were analyzed using descriptive and structural analysis through Partial Least Square Equation Modeling (SEM-PLS). The outer model demonstrated construct validity (λ > 0.5) and high reliability (composite reliability > 0.7). The inner model exhibited moderate power (R2 > 0.33) and predictive relevance (1.009). Goodness-of-fit indicators (RMS Theta = 0.072, NFI = 0.971, SRMR = 0.098) confirmed the model's suitability. Hypothesis testing indicated the significance of all variables (p < 0.05). The findings support the application of a spiritual-based palliative nursing model to enhance the quality of life for PLHIV. This model offers a holistic approach encompassing physical, psychological, social, and spiritual well-being, providing a comprehensive framework for healthcare providers and policymakers to improve care for PLHIV.

Quality of Life of People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Monastir, Tunisia.

Despite the benefits of an efficient antiretroviral therapy (ART), HIV/AIDS epidemic still represents the most seriousaffection worldwide that negatively impacts people's quality of life (QoL). As no studies exist on QoL in Tunisia, the aim of the present work was i: to assess, based on WHOQOL-HIV BREF tool, the perception of QoL of people living with HIV (PLHIV) receiving ART and ii: to investigate the relationship between socio-demographic features, disease-related variables and QoL domains' mean scores. This cross-sectional study was conducted at the department of infectious diseases of F. Bourguiba Teaching Hospital in Monastir, Tunisia. One hundred and five participants receiving ART were involved. QoL assessment was based on the WHOQOL-HIV Bref including six domains with 29 items with scores ranged from the lowest (4) to the highest (20). Results were reported as frequencies and means (±SD). The Student's t-test for independent samples and the one-way ANOVA were performed to assess differences in QoL mean scores. Linear regression analysis was used to investigate predictors of QoL. The confidence interval was set at 95%. Clients' mean age was 39.20±10.18 years old with a male to female sex ratio of 3.12. Low mean scores were seen with the environment (12.34±2.90), social relations (12.58±3.94) and psychological domains (12.76±3.31), and moderate mean scores were noted for the physical (14.11±3.52), the spiritual (14.05±3.78) and the level of independence (13.98±3.57) domains. Regression analysis showed that health status and feeling healthy were related to all QoL domains and that profession, marital status and the presence of a confident person were related to environment and spiritual domains. QoL of PLHIV on ART is affected. Concrete measures and strategies should be undertaken by healthcare stakeholders to improve QoL determinants.

Disruption of blood-brain barrier: effects of HIV Tat on brain microvascular endothelial cells and tight junction proteins.

Although the widespread use of antiretroviral therapy (ART) has prolonged the life span of people living with HIV (PLWH), the incidence of HIV-associated neurocognitive disorders (HAND) in PLWH is also gradually increasing, seriously affecting the quality of life for PLWH. However, the pathogenesis of HAND has not been elucidated, which leaves HAND without effective treatment. HIV protein transactivator of transcription (Tat), as an important regulatory protein, is crucial in the pathogenesis of HAND, and its mechanism of HAND has received widespread attention. The blood-brain barrier (BBB) and its cellular component brain microvascular endothelial cells (BMVECs) play a necessary role in protecting the central nervous system (CNS), and their damage associated with Tat is a potential therapeutic target of HAND. In this review, we will study the Tat-mediated damage mechanism of the BBB andpresent multiple lines of evidence related to BMVEC damage caused by Tat.

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.

Prevalence of and factors associated with diabetes mellitus among people living with HIV in Vietnam.

Studies have shown that people living with HIV (PLWH) have a higher risk of having non-communicable diseases (NCDs) than do people without HIV. In Vietnam, HIV remains a major public health concern, and with recent rapid economic growth, NCDs such as diabetes mellitus (DM) have become a significant disease burden. This cross-sectional study was conducted to examine the prevalence of DM and the factors associated with DM among PLWH on antiretroviral therapy (ART). In total, 1,212 PLWH were included in the study. The age-standardized prevalence of DM and pre-diabetes were 9.29% and 10.32%, respectively. In the multivariate logistic regression analysis, male sex, age above 50 years, and body mass index ≥ 25 kg/m2 were associated with DM, and borderline p-value was found for associations with current smoking and years on ART. The results suggest higher DM prevalence among PLWH and that longer time on ART could be an important risk factor for DM among PLWH. These findings also suggest that interventions such as weight control and smoking cessation support could be provided at outpatient clinics. Integration of HIV/AIDS and NCDs services is essential to address health needs comprehensively and enhance health-related quality of life for PLWH.

Quality of Life and Its Association With HIV-Related Stigma Among People Living With HIV in Kerman, Iran: A Cross-Sectional Study.

This study aimed to evaluate the quality of life (QoL) and its association with HIV-related stigma among people living with HIV (PLHIV) in Kerman province, southeast Iran. A convenience sample of 104 PLHIV was recruited. Data on QoL were collected using the HIV/AIDS-Targeted QoL instrument. Internal and external stigma were measured using an instrument developed by UNAIDS. The average QoL score was 52.5 ( SD =13.9). In multivariable model, PLHIV who experienced higher external stigma score (B = -1.9; 95% confidence interval [CI]: -2.6 to -1.1) and higher internal stigma score (B = -1.1; 95% CI: -1.5 to -0.6) had lower level of QoL. The low level of QoL among PLHIV in Iran indicates the need for initiatives to increase QoL among this population. Our data suggest that QoL in PLHIV could be improved by interventions aimed at reducing stigma in both community and health care settings.

Home-based interventions to promote physical activity for people living with HIV – a systematic review

ABSTRACT Although physical activity (PA) improves the physical, mental, and social outcomes of people living with HIV (PLH), multiple barriers prevent them from exercising. In this systematic review, we investigated the effect of home-based interventions to promote physical activity (HBI) among PLH. Randomised trials and quasi-experimental studies published in English until March 2020 were sought in five databases. Independent reviewers performed data extraction, risk of bias assessment and pragmatic-explanatory (PRECIS-2) evaluation of study characteristics. Outcomes included engagement in PA, body composition, cardiorespiratory fitness, strength, metabolic disturbances, and quality of life (QoL). Out of 480 retrieved references, six studies met inclusion criteria. Interventions lasted 12–48 weeks and involved 400 individuals (57.8% women). Ninety-eight (24.5%) participants completed interventions, but dropout rates varied considerably (5.0–54.5%). Resulted showed increased PA (two studies) and improved cardiorespiratory fitness or strength (three and two studies, respectively). Four studies demonstrated reduction of waist circumference and increase in lean body mass. QoL improved in two of three studies. We conclude HBI (aerobic and/or resistance exercises) may contribute to improve PA and/or cardiorespiratory fitness, body composition, strength and QoL of PLH. Further investigation using multi-centre standardised protocols is warranted to provide stronger evidence of their effectiveness in health promotion for PLH.

Quality of life in people living with HIV in Aotearoa New Zealand: an exploratory cross-sectional study

ABSTRACT Quality of life (QoL) in people living with HIV (PLHIV) is reportedly worse than in people without HIV, with many factors impacting on this. We aimed to investigate QoL in PLHIV in New Zealand (NZ). In-person interviews were conducted including socio-demographic, health, social connectedness, and stigma-related questions. QoL was measured using the 13-question PozQoL Scale – summed to give a score between 13 and 65. Univariate linear regression was used to investigate factors associated with differences in PozQoL scores. PLHIV (n = 188) of different ethnicities from throughout NZ participated. The mean age was 47 years; 65% were men; 61% were men who have sex with men; 61% had been living with HIV for ≥10 years. The mean summary PozQoL score was 47.16. Factors associated with a lower mean PozQol included no sex in the last 12 months (−9.03), inability to meet basic needs (−7.47), ever (−6.49) or recently (−5.03), experiencing stigma or discrimination, mental health condition (−5.74), HIV diagnosis <5 years (−5.48), poor health (−5.43), being unemployed (−5.02), not having support (−4.71), and greater internalised stigma (−2.81). Improving QoL will require investment in peer support and community welfare programmes to better support PLHIV, and stigma reduction campaigns targeting the broader community.

Quality of Life and Associated Factors in HIV-infected Adults Undergoing Antiretroviral Treatment at CHUD-Borgou

<i>Introduction</i>: Antiretrovirals have improved the life expectancy of people living with HIV (PLHIV). The evaluation of quality of life and its improvement is now an important element of care. The current study assessed the quality of life and identified associated factors with adults living with HIV who were followed at the CHUD Borgou. <i>Methods</i>: A case-control study was conducted from August to October 2018. Cases of PLHIV aged 15 years and older, were recruited through systematic sampling with steps equal to 2 based on the order of arrival of patients at the site. The controls were composed of apparently healthy, HIV-negative individuals recruited in the community in 10 neighborhoods selected at random out of 58 in the city of Parakou. A pen rotation was used to choose the direction to follow and households were selected with a step size of 4. Each PLHIV is associated with two HIV-negative respondents matched on age, sex, and average monthly income. The generic score composed of 36 questions "SF-36" was used to assess the quality of life of the participants. These questions are grouped into three categories exploring physical, mental, and self-perceived health changes, respectively. Respondents gave oral consent. The favorable opinion of the ethics committee for Biomedical research of the University of Parakou was obtained. Data were entered and analyzed using Epi-Info 7.2.2 software. The general linear regression model was used to identify independent factors associated with quality of life. <i>Results</i>: There were 222 PLHIV and 444 HIV-negative subjects. The mean quality of life score of PLHIV was higher than that of HIV-negative subjects in all dimensions: physical health (56.04 vs. 50.52; p ˂ 0.000), mental health (40.15 vs. 35.16; p ˂ 0.000), and perceived health (67.00 vs. 59.40; p < 0.000). PLHIV had a low vitality score compared with controls (53.67 vs 54.85; p = 0.215). Independent factors associated with quality of life were: age < 40 years (p=0.001), male gender (p=0.046), shared HIV status with spouse (p=0.045), existence of psychological support (p=0.026), length of time since testing (p=0.041), last CD4 ≥ 500 (p=0.025). <i>Conclusion</i>: Several factors contribute to a better quality of life for PLHIV compared to the community. The impact of free care in Benin on the quality of life of PLHIV deserves to be evaluated in the long term.

A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States.

HIV-associated neurocognitive disorder (HAND) is experienced by 30% to 50% of people living with HIV (PLWH), potentially affecting their quality of life (QoL). In the Training on Purpose Study, we investigated whether targeted cognitive training can improve QoL in PLWH with HAND. Using a two-group experimental design, we randomized 109 adults with HAND to either (a) the Individualized-Targeted Cognitive Training group or (b) a no-contact control group. Those in the training group were assigned 10 hr of cognitive training per two selected cognitive domains (20 hr total) for which impairment was observed. Overall, two patterns emerged. First, significant improvements in measures of everyday cognitive complaints, depression, and mental health were consistently observed after the completion of many cognitive training protocols. Second, immediate and delayed spatial learning and memory training resulted in more significant indicators of QoL improvements compared with the other cognitive domain trainings. The findings suggest that some types of cognitive training may have advantages over others in improving aspects of QoL.

Depressive symptoms are associated with immunological failure among HIV-positive patients in Vietnam

ABSTRACT As the lives of people living with HIV (PLWH) become increasingly normalized, more focus is being given to the associated comorbidities of HIV, including those related to mental health such as depression. This study aims to evaluate the correlation between depressive symptoms and HIV outcomes in Vietnam through the measurement of CD4 cell count. A mixed design was utilized, in which both a longitudinal assessment of CD4 cell counts and a cross-sectional survey of depressive symptoms were conducted on 481 patients in the Bach Mai and Ha Dong HIV clinics (Hanoi, Vietnam). CD4 cell count data was extracted from the medical records of participants, and depressive symptoms were screened using the Patient Health Questionnaire (PHQ-9). The results illustrate that the presence of moderately severe to severe depressive symptoms is associated with lower CD4 cell counts, indicating poorer HIV outcomes resulting from comorbid depression. This correlation was especially noticeable in the PHQ-9 items for psychomotor agitation/retardation (p < 0.05) and suicidal ideation (p < 0.05). Future policy and treatment options for HIV in Vietnam should consider the presence of comorbid mental health conditions in order to provide more suitable and effective treatment in the goal of providing a higher quality of life for PLWH.

Quality of life in people living with HIV-associated neurocognitive disorder: A scoping review study.

Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a 'fourth 90' in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed.

Effects of Antiretroviral Therapy in the Central Nervous System: Beyond Viral Suppression.

Persistence of cognitive, behavioral and, to a lesser extent, motor dysfunction in People living with HIV (PLWH) despite viral suppression has raised the question about the potential contribution of antiretroviral (ARV) compounds themselves. Converging clinical and experimental evidence support a contribution of ARV compounds. In this issue we explore the existing clinical evidence on the impact of antiretroviral therapy (ART) on the CNS across the age continuum and in women. We further examine cell type specific effects of ARV drugs as well as the class specific effects. Finally, underlying mechanisms for the observed clinical and experimental ARV-induced effects are discussed. To improve the quality of life for PLWH who are dependent on life-long ART for viral suppression, it is critical to minimize ARV-induced cellular and tissue dysfunction in the CNS.