Long-Term HIV Infection and Health-Related Quality of Life

October 21, 2014

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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.

Study Details

Scientists amassed data from the following two studies:

ASTRA (Antiretrovirals, Sexual Transmission Risk and Attitudes study)

ASTRA surveyed about 5% of the people diagnosed with HIV in the UK. Below are some key points summarizing information about participants in ASTRA:

  • the survey was done from 2011 to the end of 2012; additional information was retrieved from medical records of participants
  • data were analysed from 3,151 HIV-positive people
  • participants were mostly male (81%), and of those, mostly gay or bisexual
  • average age was 45 years
  • a majority of participants (75%) were taking ART and most of them had a viral load less than 50 copies/ml
  • 13% of all participants had hepatitis C virus (HCV) co-infection
  • about 95% of participants had more than 200 CD4+ cells/mm3

HSE (Health Survey for England)

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:

  • data were analysed from 7,424 participants
  • on average they were about 50 years old, HIV negative and consisted of more women (56%) than men (44%)
  • the vast majority of men identified as straight
  • data about hepatitis C virus status were not available

Researchers used a survey instrument that has been well validated in different populations, including people with HIV.

Results -- Smoking

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.

Results -- HRQoL

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:

  • mobility
  • self-care
  • performing everyday activities
  • pain and/or discomfort
  • anxiety and/or depression

Furthermore, in all of these areas, the differences in HRQoL scores between HIV-positive and HIV-negative people were statistically significant.

Focus on Anxiety and Depression

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

  • HIV-positive people: 50%
  • HIV-negative people: 70%

Some anxiety and/or depression

  • HIV-positive people: 40%
  • HIV-negative people: 10%

Severe anxiety and/or depression

  • HIV-positive people: 10%
  • HIV-negative people: 3%

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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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.


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