AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #145 - Factors associated with the health-related quality of life among HIV-HCV co-infected patients: A longitudinal analysis with correction for the bias induced by missing data
Authors: Presenting Author: Dr Bruno Spire - INSERM
Additional Authors: Dr. Maria-Patrizia Carrieri, Dr. Maria Winnock, Dr. Daniel Garipuy, Dr. Daniel Vittecoq, Ms. Marion Mora, Dr. Marc-Arthur Loko, Dr. François Dabis, Dr. Bruno Spire, Dr. Dominique Salmon,
Aim: Longitudinal studies addressing factors influencing quality of life among HIV-HCV co-infected patients are sparse. It has also been shown that health-related quality of life (HRQL) may be widely affected by informative missing data. The aim of this study was to identify treatment-related and psychosocial factors associated with the physical, mental and social relations dimensions of HRQL over the 2-year follow-up of the ANRS CO13 HEPAVIH cohort, while taking into account the bias induced by missing HRQL data.
Method / Issue: HEPAVIH is a French nationwide cohort of HIV-HCV co-infected patients. A total of 1,175 patients were enrolled from 2006 to 2008. Data collection was based on clinical records and self-administered questionnaires which gathered information about patients’ psychosocial characteristics and experience with HIV and HCV diseases and treatments including self-reported discomforting side-effects and depression (CES-D). Collected data also included the multidimensional WHO-QOL BREF scale resulting in computation of three aggregated scores for physical, mental and social relations HRQL dimensions. In this analysis all patients having at least one quality of life measure available during the follow-up period were included. Among the 1,048 HIV-HCV chronically co-infected cohort participants, 760, 771 and 803 patients were selected for the physical, mental and social dimension study, respectively. First, a random effects linear model was used to identify the predictors of each HRQL score. Second, a selection model based on a Heckman two-stage approach was used, in order to account for missing data bias and to measure the extent to which this could affect the results of the first model.
Results / Comments: In all multivariate models, after adjustment for clinical characteristics, the number of self-reported side-effects causing discomfort and the presence of depressive symptoms were the main significant negative predictors of all three dimensions of the HRQL, explaining between 32.4% and 57.0% of the variance of the three scores. The mode of transmission of HCV by transfusion or heterosexual (versus IDU) and comfortable housing were independently associated with both higher physical and mental scores, whereas homosexual HCV transmission was independently associated with higher social relations score. Moreover, patients who had a job had better physical and social quality of life, and patients living with a partner exhibited higher scores of mental and social HRQL. In our study, not adjusting for missing outcome data using the Heckman approach would have introduced a significant bias in the predictors of physical HRQL, consisting in underestimation of the physical HRQL score. No selection bias was found in the mental and social relations HRQL models.
Discussion: Perceived toxicity and depressive symptoms remain the major component of impaired quality of life in HIV-HCV co-infected patients. Novel interventions, aimed at better management of side-effects and depression, are needed to improve the quality of life of such individuals.
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