title: Quality of life among individuals with HIV starting antiretroviral therapy in diverse resource-limited areas of the world.
abstract: As Antiretroviral Therapy (ART) is scaled up in low- and middle-income countries, it is important to understand Quality of Life (QOL) correlates including disease severity and person characteristics and to determine the extent of between-country differences among those with HIV. QOL and medical data were collected from 1,563 of the 1,571 participants at entry into a randomized clinical trial of ART conducted in the U.S. (n = 203) and 8 resource-limited countries (n = 1,360) in the Caribbean, South America, Asia, and Africa. Participants were interviewed prior to initiation of ART using a modified version of the ACTG SF-21, a health-related QOL measure including 8 subscales: general health perception, physical functioning, role functioning, social functioning, cognitive functioning, pain, mental health, and energy/fatigue. Other measures included demographics, CD4+ lymphocyte count, plasma HIV-1 RNA viral load. Higher quality of life in each of the 8 QOL subscales was associated with higher CD4+ lymphocyte category. General health perception, physical functioning, role functioning, and energy/fatigue varied by plasma HIV-1 RNA viral load categories. Each QOL subscale included significant variation by country. Only the social functioning subscale varied by sex, with men having greater impairments than women, and only the physical functioning subscale varied by age category. This was the first large-scale international ART trial to conduct a standardized assessment of QOL in diverse international settings, thus demonstrating that implementation of the behavioral assessment was feasible. QOL indicators at study entry varied with disease severity, demographics, and country. The relationship of these measures to treatment outcomes can and should be examined in clinical trials of ART in resource-limited settings using similar methodologies.
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, 02445, USA. ssafren@partners.org
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Hendriksen
authors.forename: Laura
authors.initials: L
authors.lastname: Smeaton
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Ronald
authors.initials: R
authors.lastname: Barnett
authors.forename: Juan
authors.initials: J
authors.lastname: Guanira
authors.forename: Timothy
authors.initials: T
authors.lastname: Flanigan
authors.forename: N
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Karin
authors.initials: K
authors.lastname: Klingman
authors.forename: Thomas
authors.initials: T
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003906:Developing Countries; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015497:HIV-1 / Q000302:isolation & purification*; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013020:South America / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents