The study team also found that HIV-positive people with the following factors were more likely to have reduced HRQoL compared to HIV-negative people:
- people of colour
- women (compared to straight men)
Changes With Time
When researchers checked the year when people became HIV positive with their HRQoL score, they noticed that there was a clear trend: The further back in time someone was infected, the more likely that they experienced poor HRQoL in the present era. Further analyses found that this was not merely due to an effect related to the age of participants. That is, there was no evidence that as HIV-positive people aged they experienced worse HRQoL compared to HIV-negative people. Additional analyses are needed to understand why some people who were diagnosed in the pre-HAART era are more likely to have worse HRQoL today than people diagnosed in the recent era. The researchers plan to assess differences between participants who never experienced AIDS-related illness and those who had in order to determine if this made a difference in HRQoL.
Why the Differences?
The present analyses of ASTRA and HSE are cross-sectional in nature. Such an analysis or study design is analogous to a snapshot taken at one point in time. In such analyses, drawing firm conclusions between cause and effect is difficult. However, it is possible to place the ASTRA and HSE findings in context as we do in the following paragraphs.
Since the onset of the AIDS pandemic, mental health and emotional issues have been areas of concern for both HIV-positive and HIV-negative people. American physician Richard Glass, who observed the impact of the arrival of the HIV pandemic, proposed that "the intensity of emotional responses to AIDS may be at least partially due to its linkage with two of life's most powerful experiences -- sex and death." In the early era of AIDS, there was no effective treatment.
However, in the current era, with the near-normal life span projected for some HIV-positive people taking ART in high-income countries, fears about imminent death should not be prominent. Thus, there may be other reasons in the present study that account for why anxiety and depression are occurring in some HIV-positive people in high-income countries. The British researchers put forth the following possible explanations as to why participants in ASTRA tended to have reduced HRQoL:
- living with a chronic condition
- social circumstances
- relationship issues
- prejudice and discrimination that they may face
- potential side effects of specific medicines
The researchers noted that regardless of the underlying cause(s) of anxiety and/or depression in HIV-positive people, their findings underscore the need for doctors and nurses to screen their patients for mental health and emotional issues and offer treatment (or referral to a specialist) if needed.
The present analysis also echoes a finding from many other studies: Depression and/or anxiety are issues faced by HIV-positive people in many regions, even in the current era. Undiagnosed, untreated or poorly managed mental health issues can not only affect HRQoL but a person's ability to adhere to ART and, in some cases, their survival.
The findings from the ASTRA and HSE comparisons are important. They demonstrate the need for HRQoL assessments to be done in other studies with HIV-positive people so that they can enjoy the benefits of ART and maximize their HRQoL.
HIV and Emotional Wellness -- CATIE's guide to how people with HIV can cultivate their emotional well-being
Canadian Mental Health Association
Mental health: Fighting the stigma -- Ministère de la Santé et des Services sociaux, Québec
Strengthening the aging brain -- TreatmentUpdate 203
Good for the brain -- advice from neuroscientists -- TreatmentUpdate 203
HIV and brain-related issues -- TreatmentUpdate 204
Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis
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