title: Poor quality of life among untreated Thai and Cambodian children without severe HIV symptoms.
abstract: There are limited data on quality of life (QOL) 1 in untreated HIV-infected children who do not have severe HIV symptoms. Moreover, such data do not exist for Asian children. Poor QOL could be a factor in deciding if antiretroviral therapy (ART) should be initiated. Thai and Cambodian children (n=294), aged 1-11 years, naïve to ART, with mild to moderate HIV symptoms and CD4 15-24% were enrolled. Their caregivers completed the Pediatric AIDS Clinical Trials Group QOL questionnaire prior to ART commencement. Six QOL domains were assessed using transformed scores that ranged from 0 to 100. Higher QOL scores indicated better health. Mean age was 6.1 (SD 2.8) years, mean CD4 was 723 (SD 369) cells/mm(3), 57% was female, and%CDC N:A:B was 2:63:35%. One-third knew their HIV diagnosis. Mean (SD) scores were 69.9 (17.6) for health perception, 64.5 (16.2) for physical resilience, 84.2 (15.6) for physical functioning, 77.9 (16.3) for psychosocial well-being, 74.7 (28.7) for social and role functioning, 90.0 (12.1) for health care utilization, and 87.4 (11.3) for symptoms domains. Children with CD4 counts above the 2008 World Health Organization (WHO) ART-initiation criteria (n=53) had higher scores in health perception and health care utilization than those with lower CD4 values. Younger children had poorer QOL than older children despite having similar mean CD4%. In conclusion, untreated Asian children without severe HIV symptoms had relatively low QOL scores compared to published reports in Western countries. Therapy initiation criteria by the WHO identified children with lower QOL scores to start ART; however, children who did not fit ART-initiation criteria and those who were younger also displayed poor QOL. QOL assessment should be considered in untreated children to inform decisions about when to initiate ART.
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthanakit
authors.forename: Pope
authors.initials: P
authors.lastname: Kosalaraksa
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.forename: Suparat
authors.initials: S
authors.lastname: Kanjanavanit
authors.forename: Chaiwat
authors.initials: C
authors.lastname: Ngampiyaskul
authors.forename: Jurai
authors.initials: J
authors.lastname: Wongsawat
authors.forename: Wicharn
authors.initials: W
authors.lastname: Luesomboon
authors.forename: Theshinee
authors.initials: T
authors.lastname: Chuenyam
authors.forename: Saphonn
authors.initials: S
authors.lastname: Vonthanak
authors.forename: Mean Chhi
authors.initials: MC
authors.lastname: Vun
authors.forename: Ung
authors.initials: U
authors.lastname: Vibol
authors.forename: Bun
authors.initials: B
authors.lastname: Vannary
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D018791:CD4 Lymphocyte Count; D002160:Cambodia; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D007223:Infant; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013785:Thailand