Predictors of health-related quality of life among military HIV-infected individuals

Abstract

Objectives

To determine long-term predictors of health-related quality of life (HRQOL) and evaluate the treatment effect of highly active antiretroviral therapy (HAART) on HRQOL in the US Military HIV Natural History Study (NHS) cohort.

Methods

Participants were a nested cohort of the NHS who responded to the Rand Short Form 36 questionnaire administered from 2006 to 2010. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed using standard algorithms. HAART-status was categorized as non-protease inhibitor-based (NPI-HAART), protease inhibitor-based (PI-HAART), HAART-naïve, or off-HAART. Mixed linear random effects models were used to estimate changes in PCS and MCS over time for treatment and covariates (including CD4 count, HIV viral load, medical and mental comorbidities).

Results

Eight hundred and twelve participants met the inclusion criteria. There was no difference in PCS or MCS between those on PI-HAART compared to NPI-HAART. Significant predictors of PCS were CD4 count < 200 cells/mm3 (β = − 2.90), CD4 count 200–499 cells/mm3 (β = − 0.80), and mental comorbidity (β = − 3.23). Others were medical comorbidity, AIDS-defining illness, being on NPI-HAART, HAART-naïve, age, and rank. Those with medical comorbidities experienced yearly improvement in PCS. Predictors of MCS were CD4 count < 200 cells/mm3 (β = − 2.53), mental comorbidity (β = − 4.58), and being African American (β = 2.59).

Conclusion

HRQOL was significantly affected by low CD4 count, medical and mental comorbidities. Addressing these modifiable factors would be expected to improve the physical and mental HRQOL of the cohort. Our study did not find any treatment benefit of NPI-HAART over PI-HAART on HRQOL in the long term.

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Data availability

Data for this study are available from the Infectious Disease Clinical Research Program (IDCRP), headquartered at the Uniformed Services University of the Health Sciences (USU), Department of Preventive Medicine and Biostatistics. The Informed Consent Document under which the HIV Natural History Study data were collected specifies that each use of the data will be reviewed by the Institutional Review Board. Furthermore, the data set may include Military Health System data collected under a Data Assurance Agreement that requires accounting for uses of the data. Data requests may be sent to: Address: 11,300 Rockville Pike, Suite 600, Rockville, MD 20,852; Email: contactus@idcrp.org.

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Acknowledgements

This study was conducted by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed by the Uniformed Services University of the Health Sciences (USUHS) through a cooperative agreement with The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF). This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter‐Agency Agreement Y1-AI-5072. We thank the members of the Infectious Disease Clinical Research Program HIV Working Group for collecting and reviewing study data and ensuring effective protocol operations: Brooke Army Medical Center, Fort Sam Houston, TX: S. De Leon; S. Merritt; T. Merritt; Lt Col J. Okulicz; T. Sjoberg. Madigan Army Medical Center, Joint Base Lewis McChord, WA: C. Baker; S. Chambers; R. Colombo; COL T. Ferguson; LTC A. Kunz; C. Schofield; M. Stein. National Institute of Allergy and Infectious Diseases, Bethesda, MD: J. Powers; COL (Ret.) E. Tramont. Naval Medical Center Portsmouth, Portsmouth, VA: S. Banks; CAPT K. Kronmann; T. Lalani; R. Tant; T. Warkentien. Naval Medical Center San Diego, San Diego, CA: S. Cammarata; N. Kirkland; CAPT R. Maves; CAPT (Ret.) G. Utz. Tripler Army Medical Center, Honolulu, HI: COL M. Price. Uniformed Services University of the Health Sciences, Bethesda, MD: B. Agan; X. Chu; C. Estupigan; W. Horton; H. Hsieh; A. Noiman; E. Parmelee; D. Tribble; X. Wang; S. Won. Walter Reed Army Institute of Research, Silver Spring, MD: T. Crowell; S. Peel. Walter Reed National Military Medical Center, Bethesda, MD: I. Barahona; LTC J. Blaylock; C. Decker; A. Ganesan; COL R. Ressner; D. Wallace.

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Correspondence to Brian K. Agan.

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Emuren, L., Welles, S., Macalino, G. et al. Predictors of health-related quality of life among military HIV-infected individuals. Qual Life Res 29, 1855–1869 (2020). https://doi.org/10.1007/s11136-020-02441-5

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Keywords

  • HIV
  • Health-related quality of life
  • Highly active antiretroviral therapy
  • Physical component summary scores
  • Mental component summary scores