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Patient-reported quality of life may predict survival among patients with HIV receiving ART

Issue: February 2010

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The mortality rate for patients with HIV who are receiving antiretroviral therapy may be lower for patients who reported a higher quality of life, according to results of a recent study.

Previous studies examining the effect of self-reported health-related quality of life on patients with HIV have been conducted, but those studies occurred before the introduction of HAART, included only a few patients on HAART or had a limited follow-up duration. In the current study, the researchers examined associations between health-related quality of life and HAART.

Patients with HIV were eligible if they were involved in the focus group of the AIDS Therapy Evaluation in the Netherlands study and had started receiving HAART. Eligible patients completed the Medical Outcomes Study HIV Health Survey upon entry, which took place between May 1, 1998, and Dec. 31, 2000.

The researchers calculated physical health summary and mental health summary scores and established data for all-cause mortality on March 31, 2008.

Results

The median time to follow-up was 8.4 years. There were 66 deaths among 584 participants (11.8%).

Significant associations between quartiles of physical health summary scores and survival were observed (P<.001, log rank test).

The researchers divided the health summary scores into four quartiles, with quartile 1 indicating the worst health-related quality of life and quartile 4 indicating the best health-related quality of life. Among patients who had a physical health summary, 20% died in quartile 1, 13% died in quartile 2, 8% died in quartile 3 and 4% died in quartile 4 (P<.001).

Survival was predicted by physical functioning (P≤.001), pain (P≤.001), role functioning (P≤.001), social functioning (P≤.001) and general health (P≤.001).

The association between physical health summary and survival was independent of other clinical parameters. Results of a multivariate analysis indicate that for each five-point increase in the physical health summary score, the hazard ratio (HR) for protecting for the risk of death was 0.8 (95% CI, 0.7-0.9). No treatment before initiation of HAART also had a similar protective effect (HR, 0.1; 95% CI, 0.05-0.2).

An increased risk for death was observed among the following variables: higher age (HR for each 5 years, 1.3; 95% CI, 1.1-1.5), a CD4 cell count less than 200 X 10⁶/L at HAART initiation (HR, 2.1; 95% CI, 1.2-3.8) and having a detectable viral load at entry to the study (HR, 5.2; 95% CI, 2.8-9.4).

All variables in the analysis met the proportional hazards assumption (P>05).

There was no link between mental health summary and survival (P=.13). Among patients who had a mental health summary, 11% died in quartile 1, 13% died in quartile 2, 12% died in quartile 3 and 8% died in quartile 4 (P=.52).

De Boer-van der Kolk IM. Clin Infect Dis. 2010;50:255-263.