title: The impact of HIV status, HIV disease progression, and post-traumatic stress symptoms on the health-related quality of life of Rwandan women genocide survivors.
abstract: OBJECTIVE
  We examined whether established associations between HIV disease and HIV disease progression on worse health-related quality of life (HQOL) were applicable to women with severe trauma histories, in this case Rwandan women genocide survivors, the majority of whom were HIV-infected. Additionally, this study attempted to clarify whether post-traumatic stress symptoms were uniquely associated with HQOL or confounded with depression.
  
  
  METHODS
  The Rwandan Women's Interassociation Study and Assessment was a longitudinal prospective study of HIV-infected and uninfected women. At study entry, 922 women (705 HIV+ and 217 HIV-) completed measures of symptoms of post-traumatic stress and HQOL as well as other demographic, clinical, and behavioral characteristics.
  
  
  RESULTS
  Even after controlling for potential confounders and mediators, HIV+ women, in particular those with the lowest CD4 counts, scored significantly worse on HQOL and overall quality of life (QOL) than did HIV- women. Even after controlling for depression and HIV disease progression, women with more post-traumatic stress symptoms scored worse on HQOL and overall QOL than women with fewer post-traumatic stress symptoms.
  
  
  CONCLUSIONS
  This study demonstrated that post-traumatic stress symptoms were independently associated with HQOL and overall QOL, independent of depression and other confounders or potential mediators. Future research should examine whether the long-term impact of treatment on physical and psychological symptoms of HIV and post-traumatic stress symptoms would generate improvement in HQOL.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA, tgard@montefiore.org.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Gard
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
authors.forename: Eugene
authors.initials: E
authors.lastname: Mutimura
authors.forename: Adebola A
authors.initials: AA
authors.lastname: Adedimeji
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D063365:Genocide / Q000523:psychology*; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology*; D018023:HIV Seronegativity; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012432:Rwanda; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*