People living with HIV in the UK have poorer health-related quality of life (HRQoL) compared to individuals in the general population, according to research presented at the recent Joint Conference of BHIVA (British HIV Association) with BASHH (British Association for Sexual Health and HIV).
The study compared the results of two separate HRQoL surveys, one involving adults living with HIV, the other adults in the general UK population. Both were conducted between 2010 and 2011. The surveys measured five key aspects of health-related quality of life. People living with HIV were more likely to report problems for each of these. HIV continued to be associated with poorer health-related quality of life when the investigators controlled for confounding factors and restricted their analysis to people living with HIV who were taking antiretroviral therapy and had an undetectable viral load.
The investigators believe their findings show the excess burden of ill health that continues to be associated with HIV, even among people taking effective therapy.
There is a growing body of research showing that people taking HIV therapy in richer countries like the UK now have a normal life expectancy.
However, much less is known about the health-related quality of life of people living with HIV in the modern treatment era.
A team of UK investigators therefore designed a study comparing health-related quality of life between people living with HIV and HIV-negative individuals in the background UK population.
The HIV-positive population comprised 3151 outpatients recruited to the ASTRA study. The HSE study contributed 7424 individuals for the comparative HIV-negative group.
Both studies measured five aspects of health-related quality of life: mobility; self-care; ability to perform usual activities such as work, study, housework, family or leisure activities; pain/discomfort; and anxiety/depression. Answers were used to calculate a score to indicate overall HRQoL.
The majority (95%) of the participants who were living with HIV had a CD4 count above 200 cells/mm3 and three-quarters were taking antiretroviral therapy with an undetectable viral load.
There were significant differences between the people living with HIV and the HIV-negative people in the study. Individuals living with HIV were younger (median age 45 vs 49 years), more likely to be male (81 vs 43%), more likely to be men who have sex with men (67 vs 1%) and more likely to be smokers (30 vs 26%). However, people living with HIV were less likely to report heavy drinking (10 vs 20%), be in employment (58 vs 62%) or be of white race (81 vs 91%) (all comparisons significant, p < 0.05).
A higher proportion of people living with HIV than individuals in the general population reported problems with each of the five measures of HRQoL.
- Mobility: 27 vs 20%
- Self-care: 13 vs 5%
- Usual activities: 34 vs 21%
- Pain: 42 vs 40%
- Anxiety/depression: 50 vs 27%
All these differences were significant (p < 0.05).
People living with HIV also had a significantly lower overall HRQoL utility score (0.74 vs 0.82).
HIV was associated with poorer health-related quality of life even after the investigators took into account factors such as age, gender, ethnicity and smoking status (p < 0.001). The association between HIV and poorer health-related quality of life also persisted when analysis was restricted to people with a competent immune system and those with an undetectable viral load taking antiretroviral therapy (p < 0.001).
Other factors associated with poorer health-related quality of life included older age, gender (female vs MSM), smoking, lower levels of educational achievement (all p < 0.001) and non-white ethnicity (p = 0.01).
The investigators therefore conclude that people living with HIV have poorer health-related quality of life than individuals in the general population. They also believe their findings show HIV infection continues to be associated with an excess burden of ill health in the era of effective therapy.
Miners A et al. HIV and health-related quality of life in the UK – where are we now? 3rd Joint BHIVA with BASHH Conference, Liverpool, 2014.