AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #301 - What predicts health-related quality of life among HIV outpatients with ART access in a high-income country? A multicentre UK study of biomedical and psychosocial factors
Authors: Presenting Author: Dr Richard Harding - Kings College London
Additional Authors: Prof. Lorraine Sherr, Dr. Fiona Lampe, Dr. Claudine Clucas,
Aim: Recent data suggest increasing morbidity and mortality in settings with universal treatment access due to both treatment and the underlying disease, and therefore the concept of quality of life is one that is dynamic and requires careful measurement and clinical attention. This study aimed to determine the amount of variance within the visual analogue scale (VAS) that can be predicted using the existing five dimensions of the Euro-QOL 5D, to identify which domains have the greatest effect on quality of life, and to identify predictors of health-related quality of life on the VAS using both biomedical and psychosocial factors, among ambulatory HIV outpatients with access to ART in a high-income country public health service.
Method / Issue: The study used a cross-sectional self report survey design. Patients were approached consecutively and completed data on demographics, behavioural measures, and disease/treatment variables. Multiple linear regressions investigated: 1) relationship between the 5 EUROQOL dimensions (5D) and the EUROQOL Visual Analogue Scale (VAS), 2) which biomedical and psychosocial factors predicted EUROQOL-VAS.
Results / Comments: N=778 (rr 86%) participated: mean age 40.4 years, 65.&% gay/bisexual, 67.3% Caucasian, 68.5% on ART. With respect to the first model (5 dimensions of the EUOQOL) 30% reported mobility problems, 18% self care problems, 35.7% in performing usual activities, 42.3% pain and discomfort, and 55.5% anxiety or depression. All except self care were independently associated with VAS overall quality of life, and the 5 dimensions explained 45% of variance on the VAS scale. In Model 2, once the 5 EUROQOL dimensions were accounted for, physical symptoms (B=-0.113, p=0.002), treatment optimism (B=0.092, p=0.002), with the same 4 EUROQOL 4 dimensions retaining significance. Trends to significance were identified for psychological symptoms (B=-0.136, p=0.084), and for employment status (B=0.063, p=0.067). No significant association was found between VAS and gender/sexuality, age, education, ethnicity, being UK-born, in a stable relationship, having had a sexual partner, sexual risk taking, an STI diagnosis in previous 3 months, infection optimism, disclosure, ART treatment status, adherence, CD4count or viral load.
Discussion: Despite treatment advances, it is clinically important to note that physical problems explain a large amount of variance in self-rated quality of life. Although treatment use had no relationship to QOL, treatment optimism did improve QOL. Therefore greater clinical attention must be paid to the physical (and psychological) problems associated with HIV infection if optimal quality of life is to be acheived.
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