Barcelona 2013
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| Abstract #313 - Well Being and Life Expectancy | ||||
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Session: 25.2: Well Being and Life Expectancy (Parallel) on Tuesday @ 11.00-13.00 in Raval Chaired by Xiaming Li, Carlos Mur Authors: Presenting Author: Dr Bruno Spire - INSERM, UMR912 ?Economics and Social Sciences Applied to Health & Analysis of Medical Information? , France |
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| Additional Authors: | ||||
| Aim: (i) To describe changes over time in the levels and correlates of health-related quality of life (HRQL) of people living with HIV (PLWH) in France (ii) To define generational profiles of PLWH and to test their relationship with HRQL | ||||
| Method / Issue: ANRS Vespa (2,932 participants) and Vespa2 (3,022 participants) were national surveys conducted in French hospitals in 2003 and 2011, respectively, among random samples of PLWH representative of HIV-infected patients aware of their status and followed up in hospitals throughout the country. In both surveys, HRQL data were collected using the MOS SF-12 scale, which enables aggregate scores for the physical (PCS) and mental (MCS) dimensions of HRQL to be calculated. PCS and MCS range from 0 to 100, with higher scores denoting better HRQL. We compared the distributions of PCS and MCS between Vespa and Vespa2. Then, we used Heckman selection models to identify independent correlates of PCS and MCS separately in the two surveys, among a common set of socio-demographic, clinical and behavioral factors. Furthermore, we tested the relationship with HRQL of the following three generational profiles in Vespa2: individuals less than 42 years old (profile A), individuals 42 years and older diagnosed in the HAART era (time since diagnosis<16 years, profile B), and individuals 42 years and older diagnosed before the HAART era (time since HIV diagnosis ≥16 years, profile C). | ||||
| Results / Comments: PCS was significantly higher in Vespa2 than in Vespa (47.5 [47.0; 47.9] versus 43.6 [43.3; 43.8]). A trend toward higher MCS in Vespa2 was also observed, but the difference with Vespa was not significant (44.3 [43.7; 44.9] versus 43.5 [43.2; 43.9]). Such changes were observed in both men and women. Migrants from sub-Saharan Africa showed both higher PCS and higher MCS in Vespa2 than in Vespa. In both surveys, multivariate analyses adjusted for clinical factors showed that older age was independently associated with lower PCS and higher MCS, while reporting a high discomfort due to potential side-effects of antiretroviral therapy (ART) and the experience of rejection from medical staff were independently associated with both lower PCS and lower MCS. Profile A comprised 29.9% of participants in Vespa2, profile B, 33.9%, and profile C, 36.2%. Analyses of profiles confirmed the effect of older age on lower PCS and higher MCS, and showed higher MCS for individuals in profile B than for those in profile C (model coefficient [95% CI]: 3.44 [2.13; 4.74], p<0.0001 for profile B versus A; 1.66 [0.22; 3.10], p=0.02 for profile C versus A). | ||||
| Discussion: PLWH reported better physical HRQL in 2011 than in 2003, while no significant change was observed for mental HRQL. Our findings confirm the burden of ART-associated symptoms on both physical and mental HRQL. Younger PLWH report better physical HRQL and lower mental HRQL. Among older PLWH, those who lived with HIV in the pre-HAART era report lower mental HRQL than the others. Further research is needed to analyze the concept of generations according to gender, and among specific subgroups such as migrants or injecting drug users. | ||||
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