title: Relationship between CD4 count and quality of life over time among HIV patients in Uganda: a cohort study.
abstract: BACKGROUND
  Immunological markers (CD4 count) are used in developing countries to decide on initiation of antiretroviral therapy and monitor HIV/AIDS disease progression. HIV is an incurable chronic illness, making quality of life paramount. The direct relationship between quality of life and CD4 count is unclear. The purpose of this study is to determine the relationship between change in CD4 count and quality of life measures in a Ugandan cohort of people living with HIV.
  
  
  METHODS
  We prospectively assessed quality of life among 1274 HIV patients attending an HIV clinic within a national referral hospital over a period of 6 months. Quality of life was measured using an objective measure, the Medical Outcomes Study HIV health survey summarized as Physical Health Score and Mental Health Score and a subjective measure, the Global Person Generated Index. Generalized estimating equations were used to analyze the data. The primary predictor variable was change in CD4 count, and the outcome was quality of life scores. We controlled for sociodemographic characteristics, clinical factors and behavioral factors. Twenty in-depth interviews were conducted to assess patient perception of quality of life and factors influencing quality of life.
  
  
  RESULTS
  Of the 1274 patients enrolled 1159 had CD4 count at baseline and six months and 586 (51%) received antiretroviral therapy. There was no association found between change in CD4 count and quality of life scores at univariate and multivariate analysis among the study participants whether on or not on antiretroviral therapy. Participants perceived quality of life as happiness and well-being, influenced by economic status, psychosocial factors, and health status.
  
  
  CONCLUSIONS
  Clinicians and policy makers cannot rely on change in immunological markers to predict quality of life in this era of initiating antiretroviral therapy among relatively healthy patients. In addition to monitoring immunological markers, socioeconomic and psychosocial factors should be underscored in management of HIV patients.
authors.affiliation: Department of Medicine, Makerere College of Health Sciences, PO Box 7072, Kampala, Uganda. dorismutabazi@yahoo.com.
authors.forename: Doris Mutabazi
authors.initials: DM
authors.lastname: Mwesigire
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: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda. janet.seeley@mrcuganda.org.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.affiliation: Department of Medicine, Makerere College of Health Sciences, PO Box 7072, Kampala, Uganda. akatamba@yahoo.com.
authors.forename: Achilles
authors.initials: A
authors.lastname: Katamba
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology* / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life / Q000523:psychology*; D012959:Socioeconomic Factors; D014454:Uganda