Quality of life improves in most HIV patients taking HAART, but exceptions noted

The majority of people taking protease inhibitor based HAART regimens have stable or improved health related quality of life a year after starting therapy, according to a French study published in the 1^st January 2003 edition of the Journal of Acquired Immune Deficiency Syndromes. However, this was not the case for people with mild or no symptoms of HIV-infection at baseline.

People with better health related quality of life were also found by the study investigators to have higher levels of adherence to HAART.

The study involved patients enrolled in the APROCO cohort, which was set up in 1997 to examine the clinical, immunological, virologic and sociobehavioural characteristics of HIV-positive patients who started PI-based HAART treatment.

Patients enrolled on the study were asked to complete a 36 item questionnaire at enrollment, and then after four and twelve months. The questionnaire focused on eight areas of health including: physical functioning (limitations on physical activity because of ill health); social functioning (limitations on social activity because of illness); limitations on physical role; body pain; general mental health; emotional well-being; energy and fatigue; and, general health perceptions.

At each visit, the study participants’ doctors completed questionnaires which included information on HIV viral load, CD4 count and weight.

In total, 1,053 people enrolled on the study between May 1997 and June 1999, of whom 654 submitted their twelve month questionnaire, the study end-point. There were no significant differences between in age, gender or HIV clinical status at baseline between the 654 people who completed to study and the 399 patients who did not. However gay men and people with undetectable HIV viral load (66% of responders versus 54% of non-responders) were more likely to complete the study.

Overall, the clinical and biological markers of the study participants' health improved during the twelve months of the study, with a little under 64% achieving an undetectable viral load. Slightly over 63% saw their CD count increase by 100 cells/mm³ or more. However, 43.3% had to change their medication and doctors reported treatment-related side-effects in over 69% of patients, with severe side-effects recorded in over 11% of patients.

In the twelve months of the study, an overall significant improvement in six of the eight health categories included in the patients completed questionnaire was noted (the exception being body pain).

However, when compared to the general French population, significantly fewer member of this study were assessed as having a “fair” health related quality of life (HRQL) (60% of study members versus 75% of the general population). Patients assessed to have fair HRQL were found to be more likely to be already enjoying normal HRQL at baseline, and have clinical and biological markers of more severe advanced HIV-disease at enrollment. In addition, achieving an undetectable viral load and an increase in CD4 count of 100 cells/mm³ were also associated with normal HRQL at the end of the study.

By contrast, unemployed patients and those who had had diagnosed HIV-infection for eight years or more were found by the investigators to be more likely to have poorer HRQL. Treatment side-effects were also significantly associated with poorly perceived quality of life.

Adherence levels were also assessed by the investigators. To be to judged to have adhered, a patient had to report correctly taking all his or her medication in the previous four days. Only 29% of all study members satisfied this definition. Higher levels of adherence was noted amongst patients who reported normal quality of life at months four and twelve of the study.

The investigators conclude that “on average, a year on HAART leads to a significant improvement in most dimensions of HRQL.” However they note that there were important differences in the experiences of the study population and that people who started treatment with less severe symptoms of HIV-disease were less likely to report normal quality of life after a year of HAART.

“This result could be justified because patients who started treatment with moderate immune depression were more sensitive to the constraints and inconvenience of HAART than its benefits”, observe the investigators. They add that “our results indicate that a careful investigation of perceived adverse effects experienced by patients, especially for the less immunodepressed patients, should become an integral part of clinical monitoring”, particularly as poor perceptions of HRQL was associated with poorer adherence.