title: Alcoholism, HIV infection, and their comorbidity: factors affecting self-rated health-related quality of life.
abstract: OBJECTIVE
  Both alcoholism and HIV infection reduce health-related quality of life (HRQOL), and their co-occurrence is highly prevalent. We sought to determine whether comorbidity for both disorders further reduced HRQOL and what factors exacerbated or mitigated their effect.
  
  
  METHODS
  HRQOL, CD4 T-cell counts, lifetime alcohol consumption and length of sobriety, depressive symptoms (Beck Depression Inventory [BDI]-II), general cognitive status (Peabody Picture Vocabulary Test II), and other psychiatric comorbidities were assessed in patients with alcohol dependence or abuse (n = 44), HIV infection (n = 44), alcohol + HIV (n = 55), and healthy controls (n = 41).
  
  
  RESULTS
  Alcohol + HIV patients had lower HRQOL and more psychiatric comorbidities compared with patients with only HIV or those with only alcohol dependence or abuse; however, they matched HIV patients with regard to CD4 counts and matched alcohol patients on lifetime alcohol consumption. Across patient groups, higher HRQOL was associated with lower BDI scores but was not associated with age, gender, lifetime alcohol use, or viral load. HRQOL was higher for alcoholics in remission than for those currently meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. In stepwise regression, BDI total score predicted 34% of HRQOL variance in alcohol, 52% in alcohol + HIV, and 55% in HIV groups. General cognitive status contributed an additional 4% to the prediction of HRQOL but only in the alcohol + HIV group.
  
  
  CONCLUSIONS
  The superimposition of HIV infection onto alcoholism has a negative impact on HRQOL independent of the severity of either disease. Depression strongly predicts HRQOL, and general cognitive status plays a small role in enhancing quality of life for those at greatest clinical disadvantage.
authors.affiliation: Neuroscience Program, Center for Health Sciences, SRI International, 333 Ravenswood Avenue, Menlo Park, California 94025, USA.
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Rosenbloom
authors.forename: Edith V
authors.initials: EV
authors.lastname: Sullivan
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Sassoon
authors.forename: Anne
authors.initials: A
authors.lastname: O'Reilly
authors.forename: Rosemary
authors.initials: R
authors.lastname: Fama
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kemper
authors.forename: Stanley
authors.initials: S
authors.lastname: Deresinski
authors.forename: Adolf
authors.initials: A
authors.lastname: Pfefferbaum
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D001294:Attitude to Health; D015704:CD4 Antigens / Q000097:blood; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013695:Temperance; D013997:Time Factors
chemical_list: D015704:CD4 Antigens