Quality of life for children and adolescents: impact of HIV infection and antiretroviral treatment.
BACKGROUND
HIV/AIDS mortality rates in the United States are declining; pediatric HIV has become a chronic disease, with quality of life (QoL) outcomes assuming greater importance.


OBJECTIVE
To compare QoL among HIV-infected and uninfected children and to assess the impact of different antiretroviral regimens on QoL among HIV-infected children.


METHODS
Perinatally exposed, HIV-infected (N = 1847) and uninfected (N = 712) children and adolescents were studied. Among infected children, 1283 were available for the antiretroviral regimen analysis. QoL domain scores were assessed for subjects 6 months to 4 years, 5 to 11 years, and 12 to 21 years of age, and the impact of infection status and alternative treatment regimens on QoL domains was evaluated.


RESULTS
HIV infection was associated with significantly worse mean adjusted scores for functional status among children 6 months to 4 years of age and health perceptions, physical resilience, physical functioning, and social/role functioning among those 5 to 11 years of age. However, uninfected children 5 to 11 years of age reported significantly worse psychological functioning. HIV-infected children (5-11 years of age) and adolescents (12-21 years of age) receiving no antiretroviral treatment had worse health perceptions. Adolescents receiving no antiretroviral agents also had worse symptoms. When antiretroviral regimens were compared, adolescents receiving protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-containing therapy had worse symptoms, compared with those receiving protease inhibitor-containing therapy; otherwise, no significant differences were found.


CONCLUSIONS
Generally parents of HIV-infected children 6 months to 4 years and 5 to 11 years of age generally reported lower mean QoL scores than did parents of uninfected children, although worse psychological functioning was reported for uninfected children. HIV-infected adolescents not receiving antiretroviral treatment had worse health perceptions and symptoms. We found no consistent QoL differences among children receiving different antiretroviral regimens.
Lee
Grace M
GM
Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Pilgrim Health Care, Harvard Medical School, Boston, Massachusetts, USA. grace_lee@hphc.org
Gortmaker
Steven L
SL
McIntosh
Kenneth
K
Hughes
Michael D
MD
Oleske
James M
JM
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D002666:Psychology, Child; D011788:Quality of Life; D018894:Reverse Transcriptase Inhibitors; D011795:Surveys and Questionnaires
D044966:Anti-Retroviral Agents; D018894:Reverse Transcriptase Inhibitors