October 21, 2014
The widespread availability of potent combination anti-HIV therapy (commonly called ART or HAART) has greatly reduced deaths from AIDS-related infections in Canada and other high-income countries. The benefit of ART is so profound that researchers increasingly expect that some young adults who are infected today and who begin treatment shortly thereafter will likely live into their 80s.
Historically, scientists have done much work trying to understand ART's impact on HIV and the immune system. However, as ART users are living longer, research needs to be done on what scientists call health-related quality of life (HRQoL). According to scientists who study HRQoL, this term includes issues such as "physical, cognitive, emotional and social functioning."
Assessing HRQoL can be useful for understanding the experience of living with HIV, which will become more important as the population of HIV-positive people ages, and to provide necessary health and social services.
Scientists in the UK undertook studies collecting and comparing health-related information and assessments of HRQoL from 3,151 HIV-positive and 7,424 HIV-negative people. They found that, overall, HIV-positive people had reduced HRQoL. In particular, HIV-positive people were more likely to report feelings of anxiety and/or depression. Furthermore, people with HIV reported feelings of more severe anxiety and/or depression than HIV-negative people. Reduced HRQoL was more likely to occur among people who had been diagnosed with HIV in earlier decades. In HIV-positive people, aging was not linked to decreased HRQoL.
This is likely one of the largest studies to compare HRQoL between HIV-positive and HIV-negative people in a setting of universal access to health care and treatment in the current era. The study results provide clues about the issues that need to be addressed if the overall health and well-being of HIV-positive people is to be improved.
Scientists amassed data from the following two studies:
ASTRA surveyed about 5% of the people diagnosed with HIV in the UK. Below are some key points summarizing information about participants in ASTRA:
HSE surveyed randomly selected households in England in 2011; nurses interviewed participants to gather additional information not captured in the survey. Below are some key points summarizing information about participants in HSE:
Researchers used a survey instrument that has been well validated in different populations, including people with HIV.
In general, HIV-positive participants were more likely to smoke tobacco (24%) than HIV-negative participants (19%). Among smokers, HIV-positive participants were more likely to be heavy smokers (10%) than HIV-negative people (4%). This latter difference was statistically significant; that is, not likely due to chance alone. Other studies have also found higher rates of tobacco smoking among HIV-positive people.
Despite being on average four years younger than the HIV-negative participants, HIV-positive people as a group had lower HRQoL scores, with specific problems reported in the following areas:
Furthermore, in all of these areas, the differences in HRQoL scores between HIV-positive and HIV-negative people were statistically significant.
Perhaps the most striking differences in HRQoL between the two main populations analysed in the study emerged in the areas of anxiety and/or depression. Here is the distribution of participants within different categories related to mental health:
No anxiety and/or depression
Some anxiety and/or depression
Severe anxiety and/or depression
Researchers took into account many potential factors -- smoking, level of education, recent use of recreational drugs, HCV-positive status -- that could have had an impact on HRQoL and possibly accentuated the statistical differences between populations. Despite these precautions, the differences in HRQoL persisted between HIV-positive and HIV-negative people. Even when researchers engaged in an exercise by removing gay and bisexual men from their analyses, the differences persisted. Among HIV-positive people, the study's findings were the same regardless of CD4+ cell count or viral load.
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