Relationship of HIV viral loads, CD4 counts, and HAART use to health-related quality of life.
OBJECTIVE
To understand the relationship of viral load (VL), CD4 counts, and highly active antiretroviral therapy (HAART) use to health-related quality of life (HRQL).


METHODS
Cross-sectional analysis of 513 HIV-infected patients. Primary outcomes were four domains of HRQL: physical functioning (PF), role function (RF), energy levels (EL), and health perceptions (HP). The authors examined univariate and multivariate relationships between VL, CD4, and HAART use to each HRQL domain, after adjustment for potential confounders.


RESULTS
In univariate analyses, compared with patients with CD4 > 500, those with CD4 < 200 (p =.001) or 200 to 500 (p =.002) had lower PF and RF scores, and patients with undetectable VL had higher PF scores than patients with VL log10 2.6 to 4.0 (p =.02) and > log10 4.0 (p =.01). In multivariate analyses, compared with patients with CD4 > 500, patients with CD4 < 200 had lower PF (-8.8 points; p <.01), RF (-9.3 points; p <.01), and HP (-7.8 points; p <.001). Patients with log10 VL 2.6 to 4.0 had lower PF scores (-7.7 points; p <.01) versus undetectable VL. After adjusting for VL and CD4 counts, HAART use was associated with lower PF scores (-5.4 points; p <.05).


CONCLUSIONS
Efforts to improve patients' CD4 counts are likely to also improve HRQL. Lowering viral loads may improve physical functioning, but only if VL are suppressed to undetectable levels. In this analysis, HAART had negative effects on PF that were independent of its effects on CD4 and VL. For adherent patients, these adverse effects of HAART on PF are likely to be outweighed by the positive effects that HAART exerts through lowering VL and increasing CD4 counts.
Gill
Christopher J
CJ
Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts 02111, USA.
Griffith
John L
JL
Jacobson
Denise
D
Skinner
Sarah
S
Gorbach
Sherwood L
SL
Wilson
Ira B
IB
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011788:Quality of Life; D016896:Treatment Outcome; D019562:Viral Load