title: Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population.
abstract: BACKGROUND
  Combination antiretroviral therapy has substantially increased life-expectancy in people living with HIV, but the effects of chronic infection on health-related quality of life (HRQoL) are unclear. We aimed to compare HRQoL in people with HIV and the general population.
  
  
  METHODS
  We merged two UK cross-sectional surveys: the ASTRA study, which recruited participants aged 18 years or older with HIV from eight outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012; and the Health Survey for England (HSE) 2011, which measures health and health-related behaviours in individuals living in a random sample of private households in England. The ASTRA study has data for 3258 people (response rate 64%) and HSE for 8503 people aged 18 years or older (response rate 66%). HRQoL was assessed with the Euroqol 5D questionnaire 3 level (EQ-5D-3L) instrument that measures health on five domains, each with three levels. The responses are scored on a scale where a value of 1 represents perfect health and a value of 0 represents death, known as the utility score. We used multivariable models to compare utility scores between the HIV and general population samples with adjustment for several sociodemographic factors.
  
  
  RESULTS
  3151 (97%) of 3258 of participants in ASTRA and 7424 (87%) of 8503 participants in HSE had complete EQ-5D-3L data. The EQ-5D-3L utility score was lower for people with HIV compared with that in the general population (marginal effect in utility score adjusted for age, and sex/sexuality -0·11; 95% CI -0·13 to -0·10; p < 0·0001). HRQoL was lower for people with HIV for all EQ-5D-3L domains, particularly for anxiety/depression. The difference in utility score was significant after adjustment for several additional sociodemographic variables (ethnic origin, education, having children, and smoking status) and was apparent across all CD4 cell count, antiretroviral therapy, and viral load strata, but was greatest for those people diagnosed with HIV in earlier calendar periods. Reduction in HRQoL with age was not greater in people with HIV than in the general population (pinteraction > 0·05).
  
  
  CONCLUSIONS
  People living with HIV have significantly lower HRQoL than do the general population, despite most HIV positive individuals in this study being virologically and immunologically stable. Although this difference could in part be due to factors other than HIV, this study provides additional evidence of the loss of health that can be avoided through prevention of further HIV infections.
  
  
  BACKGROUND
  UK National Institute for Health Research.
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: alec.miners@lshtm.ac.uk.
authors.forename: Alec
authors.initials: A
authors.lastname: Miners
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Noemi
authors.initials: N
authors.lastname: Kreif
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Rodger
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Speakman
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Homerton University Hospital NHS Trust, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.affiliation: HIV i-Base, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Collins
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Hart
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Lampe