title: Quality of life in patients treated with first-line antiretroviral therapy containing nevirapine or efavirenz in Uganda: a prospective non-randomized study.
abstract: BACKGROUND
  The goal of antiretroviral therapy (ART) is to suppress viral replication, reduce morbidity and mortality, and improve quality of life (QoL). For resource-limited settings, the World Health Organization recommends a first-line regimen of two-nucleoside reverse-transcriptase inhibitors and one non-nucleoside transcriptase inhibitor (nevirapine (NVP) or efavirenz (EFV)). There are few data comparing the QoL impact of NVP versus EFV. This study assessed the change in QoL and factors associated with QoL among HIV patients receiving ART regimens based on EFV or NVP.
  
  
  METHODS
  We enrolled 640 people with HIV eligible for ART who received regimens including either NVP or EFV. QoL was assessed at baseline, three months and six months using Physical Health Summary (PHS) and Mental Health Summary (MHS) scores and the Global Person Generated Index (GPGI). Data were analyzed using generalized estimating equations, with ART regimen as the primary exposure, to identify associations between patient and disease factors and QoL.
  
  
  RESULTS
  QoL increased on ART. The mean QoL scores did not differ significantly for regimens based on NVP versus EFV during follow-up for MHS and GPGI regardless of CD4 stratum and for PHS among patients with a CD4 count >250 cells/μL. The PHS-adjusted β coefficients for ART regimens based on EFV versus NVP by CD4 count strata were as follows: -1.61 (95% CI -2.74, -0.49) for CD4 count <100 cells/μL; 0.82 (0.22, 1.43) for CD4 count 101-250 cells/μL; and -1.33 (-5.66, 3.00) for CD4 count >250 cells/μL. The corresponding MHS-adjusted β coefficients were as follows: -0.39 (-1.40, 0.62) for CD4 < 100 cells/μL; 0.16 (-0.66, 0.98) for CD4 count 101-250 cells/μL; and -0.75 (-2.01, 0.51) for CD4 count >250 cells/μL. The GPGI-adjusted odds ratios for EFV versus NVP were 0.51 (0.25, 1.04) for CD4 count <100 cells/μL, 0.98 (0.60, 1.58) for CD4 count 101-250 cells/μL, 1.39 (0.66, 2.90) for CD4 > 250 cells/μL. QoL improved among patients on EFV over the 6-month follow-up period (MHS p < 0.001; PHS p = 0.04, p = 0.028). Overall, patients with depression (PHS p < 0.001; GPGI p < 0.001) had lower scores and women had lower MHS (on NVP, p = 0.001). Other factors associated with lower QoL included alcohol use, low education level and advanced HIV disease.
  
  
  CONCLUSIONS
  ART improves QoL. The results support use of either NVP or EFV. Patients initiating ART should be assessed for depression and managed appropriately. Women may require extra support to improve their QoL.
authors.affiliation: Department of Medicine, Makerere College of Health Sciences, P.O.Box 7072, Kampala, Uganda. dorismutabazi@yahoo.com.
authors.forename: Doris Mutabazi
authors.initials: DM
authors.lastname: Mwesigire
authors.affiliation: Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. awu@jhu.edu.
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
authors.affiliation: Department of Psychology, University of Bath, Bath, United Kingdom. psmfm@bath.ac.uk.
authors.forename: Faith
authors.initials: F
authors.lastname: Martin
authors.affiliation: Department of Medicine, Makerere College of Health Sciences, P.O.Box 7072, Kampala, Uganda. akatamba@yahoo.com.
authors.forename: Achilles
authors.initials: A
authors.lastname: Katamba
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda. janet.seeley@mrcuganda.co.ug.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D048588:Benzoxazines / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D003863:Depression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008603:Mental Health; D019829:Nevirapine / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D014454:Uganda; D014944:World Health Organization
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine; C098320:efavirenz